Understanding Basic Test Results

Now we know why a well woman exam is integral to your health, what about the test results?  Test results can be confusing and sometimes scary. Lets take some time to really break down potential results you might see.

First, a quick review of the current CDC guidelines for screening tests:

• ​Regular Pap tests should begin at age 21 (no matter which age you become sexually active)
• Regular Pap tests and HPV test should begin co-testing at age 30
• Regular Pap and/or HPV test should continue until age 65, as directed by your doctor

Changes of the cervix, when caught and managed early, do not typically turn into cervical cancer. This is important to note.  According to the CDC, your Pap test results should be reported in one of three ways:  normal, unclear, or abnormal.  

• Normal - a normal result is great!  It means there are currently no cell changes found on your cervix.  Remember, it is important that you still go in annually for your well woman exam and follow all guidelines for your age group.
• Unclear - hearing your results are unclear, equivocal, inconclusive, or ASC-US means that your results were not clear.  It means that the cells could be abnormal.  Cells which fall into the unclear identification could be HPV related or related to changes such as pregnancy, menopause, or an infection.  If you have unclear results, at any age, it is appropriate to ask your doctor for a HPV test.
• Abnormal - an abnormal result means that the test determined there are cell changes on your cervix.  Remember, this is a screening test.  An abnormal result does not automatically mean you have cancer, it does mean the abnormal cells on your cervix are likely caused by HPV:  if you have abnormal results, at any age, it is appropriate to ask your doctor for a HPV test.  Changes are classified as minor, sometimes referred to as low-grade, or serious, sometimes referred to as high-grade.  Typically, minor changes go back to normal without medical intervention.  More serious changes can turn into cancer if they are not removed.  More serious changes are often identified as "precancer" because they have not progress to cancer.  It is important to receive treatment to remove the abnormal cells if they are identified as serious, high grade, and/or precancerous.

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Understanding Co-Testing Results:  HPV Test & Pap Test
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• Negative HPV & Normal Pap - this means you do not have HPV and your cervical cells are normal, this is great!  You have a very low chance of developing cervical cancer.  You should follow the current guidelines as provided by your ob-gyn for follow up testing.  You should also continue to go to your annual well woman exam.
• Negative HPV & Unclear Pap - this means you do not have HPV, but you may have cell changes on your cervix.  You should discuss with your ob-gyn when your next testing should be scheduled.  Typically you will need to be seen for an additional Pap test in one year, however, some doctors will want to see you sooner.  It is important to not miss your appointments for screening.
• Negative HPV & Abnormal Pap - this means your cervical cancer cells are abnormal but you do not have HPV.  It is important to find out why the two test vary.  If there are minor cell changes your doctor will need to take a closer look at your cervix to decide the next steps.  If there are serious cell changes, your doctor will need to take a closer look at your cervix and treat as soon as possible.

If you have a positive HPV test, your monitoring guidelines will look different.  It is very important that you do not disregard the guidelines. 
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• Positive HPV & Normal Pap -  this means the cells on your cervix are normal, however you do have HPV.  Some women are able to fight off the HPV naturally and never get cell changes.  Some women are not able to fight off HPV, and could cause future cell changes.  The current guidelines recommend a follow up appointment with a co-test in one year.  Cell changes typically happen slowly.  Having HPV does not mean you will develop cancer, it means you will need to be screened more closely.
• Positive HPV & Unclear Pap -  this means you do have HPV and you may have cell changes on your cervix.  Your doctor will need to take a closer look at your cervix and find out for certain if the cells on your cervix are, in fact, abnormal.  Your doctor may need to remove the abnormal cells or follow up with you more frequently to ensure the cells do not get worse.
• Positive HPV & Abnormal Pap - this means you do have HPV and your cervical cells are abnormal.  This does not immediately mean you have cancer.  Your doctor will need to take a closer look at your cervix and determine if the cell changes are minor cell changes or serious cell changes.  If it is determined that the cell changes are minor, your doctor will take a closer look at your cervix and determine the next steps.  If it is determined that the cell changes are serious, your doctor will need to take a closer look at your cervix and treat as soon as possible.

That was a lot of medical information in one place!  I hope that this post helps you to understand the guidelines which are typically used when dealing with well woman exams, Pap tests, and HPV tests.  These are all tools to help monitor a woman and screen for cervical cancer.

Are the tests 100% effective?  No, for example, when I was diagnosed with cervical cancer in October 2012 I had a biopsy of the visible tumor on my cervix as well as a Pap test.  The biopsy came back identifying that I had cervical cancer, however, my Pap test came back as normal.  I don't say this to scare you.  I say this because it is part of my story.  I want you to understand that no test is going to be 100% effective.  You need to make sure you know your body, pay attention to any changes, and advocate for yourself is something doesn't seem normal to you, it isn't normal.