Women’s Health

ASCUS on Pap Smear

ASCUS (Atypical Squamous Cells of Undetermined Significance)

The very mildest abnormalities detected on Pap smear are referred to as ASCUS (atypical typical squamous cells of undetermined significance). This term is used for reporting Pap smear findings and indicates that some flat (squamous) cells look unusual and may or may not be pre-malignant. Of all Pap tests that reveal ASCUS reading, 80-95% are caused by benign conditions, chiefly infections. The remaining 20% prove to be precancerous when further testing, such as a colposcopy is performed.

In general, women and their gynecologists find this category the most annoying. The vast majority of these are “it’s probably normal but I want to keep an eye on things”. Women become concerned that they’re harboring invasive cancer—which is virtually never the case. Gynecologists would rather tell a woman “it’s completely normal and you can return next year”. Most women whose Pap smear reveals ASCUS are best managed by repeating the smear in 3-6 months or performing an additional test called a colposcopy (See below). In general, the best treatment for ASCUS is observation combined with colposcopy, since most of these lesions will spontaneously disappear without treatment. Some cases that co-exist with a vaginal or cervical infection will require antibiotic treatment.

As I’ve already stated, a pap smear that reveals ASCUS should not be ignored as some of them, on closer examination will reveal a more significant lesion. However, once that additional test has been performed, and dysplasia has been ruled out, this abnormality can be safely watched with repeat pap smears and occasional colposcopies—they do clear up given a little time and patience.

One of the “dangers” of ASCUS is that it tends to make women anxious and they often lose sleep—especially after talking to a friend whose well-intended advice often amplifies her anxiety. Unfortunately, many women hear the words “you have an abnormal pap smear” and insist on aggressive surgery. This is generally not recommended and often produces more problems that it solves.