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What are Atypical Squamous Cells of Undetermined Significance?

Tricia Christensen
Updated Mar 03, 2024
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Atypical squamous cells of undetermined significance (ASCUS) is a mildly abnormal reading that may occur when a woman gets a PAP smear. Sometimes abnormal squamous cells are found, but their presence don't clearly indicate that there is cancerous or a precancerous state. This type of abnormal reading may mean that the patient will need a few more tests or monitoring PAP smear results over the following years to be certain there is no indication of cervical cancer. In over 80% of cases, ASCUS doesn’t represent a finding of cancer, but it’s still advised that care be taken.

The reading itself, “atypical squamous cells of undetermined significance,” says a great deal about what the test is communicating. That fact that ASC is of “undetermined significance” really says it all. The laboratory analyzing the test can’t tell how important the reading is because its significance is unknown.

Any reading that could have a small indication that cervical cancer might develop suggests additional testing. A woman who has a finding of ASCUS may be asked to undergo a screening for human papillomavirus (HPV) because many forms of it have been linked to cervical cancer. Not all women have this test, especially if they have active vaginal infections of an identified origin that might account for ASCUS result or if they are pregnant, when abnormal readings get pretty common.

There are so many things that cause an atypical squamous cells of undetermined significance result that doctors may not choose to do much. In addition to pregnancy, menstruating when the PAP smear was done or normal sexual activity just before the PAP could cause cells on the cervix to be irritated and to produce thin squamous cells. The latter cause is one reason women are asked not to engage in sexual intercourse the day before a pelvic exam.

Given these normal causes of ASCUS, a lot of doctors just choose to do a repeat PAP smear the following year to see if abnormal results remain. On the other hand, if a woman is reasonably at higher risk for cervical cancer, a finding of atypical squamous cells of undetermined significance might suggest a more extensive form of cervical examination and biopsy called a colposcopy. This can better evaluate the cervix by examining it microscopically, and a doctor could then take small samples of any areas that appear to be of concern.

In most cases, a laboratory result of atypical squamous cells of undetermined significance doesn’t mean much, though it does require some follow-up. Most women may get this result once and never have another abnormal PAP smear again. It is still important to recognize the possible significance of ASCUS and be certain to follow through with doctor recommendations for additional treatments or exams.

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Tricia Christensen
By Tricia Christensen , Writer
With a Literature degree from Sonoma State University and years of experience as a TheHealthBoard contributor, Tricia Christensen is based in Northern California and brings a wealth of knowledge and passion to her writing. Her wide-ranging interests include reading, writing, medicine, art, film, history, politics, ethics, and religion, all of which she incorporates into her informative articles. Tricia is currently working on her first novel.

Discussion Comments

By anon999406 — On Dec 28, 2017

For those who have gone through the experience of getting results of an abnormal pap smear with ASCUS. A medical assistant from my doctor's office told me the results showed positive for HPV yet when I look through the results, nowhere does it say anything about HPV. Can anyone address my concerns? I have basic knowledge through my education and such but being told that over the phone changes your ideas and makes you question what you know. Thank you.

By HelenRd — On Oct 28, 2012

This is the part that is of concern to me though -- it's just that when so much of your body sheds itself like that, it's like it's pleading for help and protection from another brutal attack like that again.

By anon224862 — On Oct 24, 2011

A colposcopy is not that painful. It is pretty much a regular pap, but they swab you with something pretty much the same as vinegar. Let it sit a minute and then look with a light and scope to see if the bad cells turn white. Then, if so, they usually take a biopsy of the area to further test. The biopsy part is what can be painful. Other than that it's not actually that bad. It just depends on how big a spot they are taking about.

I have had several of them and the leap is actually a surgery to remove parts of the lining of the cervix. It is a little painful afterwards, but not near as bad as some other procedures. I had one about nine years ago. There was just lots of cramping and maybe some bleeding afterwards. Recently I have found out that mine has come back, and I have to go through it again.

By cmsykes — On Apr 26, 2011

Yes! A colposcopy is painful and don't let them tell you its not! Unless you have a very high threshold for pain, which I thought I did, ask your doctor to prescribe something to take for pain prior to the procedure as well as something to help you relax. You can expect cramping and nasty discharge.

By anon167366 — On Apr 12, 2011

I would like to know what it means when a woman is diagnosed with HPV then three years later be diagnosed with ASCUS when she does not have a cervix and is not sexually active?

By donna61 — On Jan 29, 2011

I had read somewhere that sometimes after the test result of ASCUS, the doctor will do further testing -- something called a LEEP, I think. I hope I never have to have a procedure like that, since it can cause some pretty nasty side effects (pain, cramps, vaginal bleeding and discharge, that kind of thing).

What I didn't understand from the article I read on this was why such further tests would be necessary. When would this be the appropriate follow up?

By visionary — On Jan 27, 2011

@healthnwell -- A colposcopy is a test where the doctor takes a closer look at the vaginal tissue. The colposcope is similar to a microscope with a light on the end of it. The light will "go through" the healthy tissue. The doctor will focus on any tissue the light does not go through, typically it appears white. The whiter the tissue, the more abnormal. Before the doctor looks with the colposcope, an acetic acid is placed on the vaginal tissue. This is typically a painfree procedure, pretty much like your normal gynecological visit.

However, unlike a normal gynecological visit, a colposcopy has a much higher focus, which is what makes it good for dealing with ASCUS.

By healthnwell — On Jan 26, 2011

What is a colposcopy, and is it painful?

By famnfriends — On Jan 24, 2011

ASCUS can also happen as a women becomes peri-menopausal or menopausal. This is a condition known as vaginal atrophy. Not dangerous, but can be uncomfortable.

Tricia Christensen

Tricia Christensen


With a Literature degree from Sonoma State University and years of experience as a TheHealthBoard contributor, Tricia...
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