Two recent developments involving the reporting of Pap smear results and managing the treatment of inconclusive findings offer women a more defined plan of action and more convenient follow-up. These developments should help reduce anxiety for a large number of the more than two million women annually whose routine Pap test results are reported as inconclusive, insufficient, or unsatisfactory.

For women, a Pap smear is a routine part of a gynecological exam. However, these tests can cause a great deal of stress when results are returned from the lab indicating cervical abnormalities. Many times, the lab is unable to tell whether these abnormalities are benign (harmless) or early signs of disease (such as cervical cancer). This may be because of factors affecting the quality of the specimen obtained, preservation of the specimen, or the presence of certain cells that are not typical of cancer but that still appear abnormal. Of the 50 million women who get Pap smears in the U.S. each year, over 2 million receive results that suggest additional follow-up is necessary.

How exactly to evaluate these inconclusive Pap smear results was the subject of a recent conference of experts in the diagnosis and management of cervical caner from 29 professional, government, and health organizations. Sponsored by the American Society for Colposcopy and Cervical Pathology (ASCCP), the panel produced guidelines for how to manage the treatment of women with cervical cytological (relating to cells) abnormalities that are based on new, evidence-based research that has improved our understanding of what causes cervical cancer, such as human papilloma virus (HPV).

In addition, the guidelines incorporated revisions to the criteria by which labs report Pap smear results, called the 2001 Bethesda System, which were also just recently published by the National Cancer Institute. Major changes in the Bethesda reporting system from earlier versions include incorporation of criteria specific to the newer, liquid-based Pap smear technology. The 2001 Bethesda System addresses how laboratory results are to be reported using modified categories that determine appropriate follow-up.

The updated Bethesda classification coincides with the use of ASCCP management guidelines to make an important distinction in the follow-up care women receive. If the Pap smear result is reported as “ASC-US” (atypical squamous cells of undetermined significance), the preferred method of follow-up is a program of two repeat Pap smears, immediate colposcopy (examination of the cervix with or without a biopsy), and/or DNA testing for high-risk strains of HPV. HPV testing can be conveniently performed and is recommended when liquid-based screening methods are used. This recommendation stems from evidence that a few high-risk types of HPV are the primary causes of cervical cancer. However, if the Pap smear result has been reported as “ASC-H” (atypical squamous cells - high grade), the best approach, according to the guidelines, is immediate colposcopic examination, generally including multiple biopsies of the cervix.

The results as defined through these new guidelines offer a more defined plan of action and reduce the need for multiple Pap smears. If a liquid-based Pap smear is performed, an HPV test can usually be done as follow-up to an abnormal result; therefore, the patient generally does not have to return to the office to give another sample.

An important advantage in implementing both of these new guidelines is that together they provide a uniform method of talking about and treating cervical abnormalities. This ensures better quality treatment when needed and fewer repeat or unnecessary follow-up procedures that may result form previously reported formats stating “inconclusive results.” It is believed that more than 90% of labs in the U.S. follow the Bethesda System, which should lead to greater consistency wherever women go for their Pap testing.