How to Interpret Your Cervical/Pap Smear Results

The purpose of this hub is to give an explanation of the types of results you can get from a cervical smear.

The most important thing to remember is that most (90+%) results are not cancer - they are PRECANCEROUS changes - so, essentially, changes that could lead eventually to cancer in 10-15 years if you do nothing about them

Countries around the world differ slightly in the way that they present results of Cervical/Pap smears. This article will discuss results within the Bethesda system, as the author is from New Zealand, who use the Bethesda system. However, the explanations should be clear enough to give an understanding regardless of the reporting system used.

Most cervical changes are caused by a virus - HPV or Human Papillioma Virus - or the "Warts Virus". Yes. the same one that causes warts on your hands, or genital warts. However, there are hundreds of strains of this virus, so different ones cause warts on your hands, to the ones 'down there', to the ones that cause cervical changes.

Genital warts are caused by strains 6 and 11, Cervical Changes by approximately 40 different strains - the most common (and Highest Risk) are 16 and 18. Yes, it's an STI - but it's much like the common cold - if you've had sex, you've usually got it at some point in your life, and this is accurate for about 70% of the population

• Normal - this is a good one! There is no evidence of maligancy in the cells collected from your cervix. Continue on with recommended regular screening as recommended by your healthcare provider
• ASCUS - Atypical Squamous Cells of Undetermined Significance - So, these cells are a little unusual looking, but not unusual enough to be deemed "Low Grade" - usually you will need to have your next smear a little earlier than usual, unless you've had a previous ASCUS, Low Grade, or High Grade.
• LSIL - Low Grade Squamous Intraepithelial Lesion - Sounds scary - this is just a low grade change. Often this is the presence of the HPV virus (discussed earlier), and if you have two of these in a space of 5 yrs, you may be referred to Colposcopy - which is just more specialised test really (see below). If it's the first one, you'll be asked to have your next smear sooner than usual.
• ASC-H/ASCUS?H - Atypical Squamous Cells of Undetermined Significance ?High Grade. - So, these are odd looking cells again, that don't quite fit in the Low Grade area, but don't quite reach the High Grade level. They also don't fit the ASCUS level. This still isn't cancer. What happens now is that you will be referred to Colposcopy for a closer look, even if it is your first result of ASC-H. Don't panic - it's not as scary as you think - I promise.
• HSIL - High Grade Squamous Intraepithilial Lesion - STILL not cancer. These are higher grade lesions, that are not cancer, but the space between the nucleus of the cell, and the outside is very small, given that the nucleus of the abnormal cell is big. This needs treatment, so you will be referred to Colposcopy.
• AIS - Adenocarcinoma in situ - This one isn't yet cancer either, but is as much like HSIL, except is usually found further up the canal of the cervix. This also requires colposcopy. There are slightly more invasive treatment options for this if confirmed on biopsy - but at this point, it is no reason to panic.
• ? Invasive Carcinoma/SCC/Adenocarcinoma - This is supicious cancer. However, on a smear result this is usually reported as ? invasive - as this CANNOT BE CONFIRMED until you have had a Colposcopy and biopsy.

Colposcopy is not as scary as it may seem, or sound. It is also necessary - to ensure the accuracy of the results, provide a diagnosis and treatment plan, and treatment.

Many of the abnormal results can be removed easily with a procedure done at the same time as a follow up colposcopy, before they turn into malignant cells.

But remember:

HAVE YOUR SMEAR DONE! You are WORTH it!