[Question #7585] Atypical Glandular Cells with Negative HVP cancer risk?

3 months ago
Hello, my wife is 43 years old and has had normal pap results all her life. In April 2020, her pap came back ASC-US, and positive for HR-HPV (but not 16 or 18). She had a colposcopy in Sept 2020, which came back normal. Also, she became pregnant in March 2020 and had a c-section delivery in Nov 2020, less than 2 months ago.
Last week, she had another pap, which came back Abnormal, with Atypical Glandular Cells (AGC), and NEGATIVE for HR-HPV. She is going back for a colposcopy and biopsy ASAP.
We are scared this could mean cancer. So, our questions are:
1. Since her normal colposcopy in Sept 2020, could invasive cancer have developed so quickly?
2. What percentage of AGC develop into cancer?
3. Are Atypical Glandular Cells the worst result you can get on a pap test?
Thank you so much!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome back to the forum.

If there were cancer cells in the Pap smear, that's what the report would say. Atypical glandular cells are not cancer and usually not serious. She should discuss the result with her doctor, but I see no reason for worry.

Those comments pretty well cover your questions, but to assure no misunderstanding:

1. She doesn't have cancer, invasive or otherwise. Even when cancer cells first develop -- which pap smears easily detect -- it usually takes several years to become invasive.
2. To my knowledge, AGC never develops into cancer.
3. It's the opposite to "the worst result" -- nothing to worry about. As I said, she should discuss it with her doctor.

This and your previous question indicate you're quite obsessed with your wife's Pap smears. It's unnecessary, given the mild abnormalities she had, both last time and this time. It would be best for you to stop reading her Pap smear results. If there's anything important for her health, her doctor will inform her. 

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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3 months ago
Dr. Handsfield, thank you for your quick reply. Just to follow up, in my reading, it seems AGC is one of the more serious abnormal PAP results. 
For example, I found this statistic.

The risk that atypical glandular cell (AGC) abnormalities reflect precancerous changes is as high as 35 percent, the risk of cervical cancer is as high as 1 percent, and the risk of endometrial (uterine) cancer is as high as 3 percent.”

What do you think? Thanks! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
We're STD experts here, which includes HPV infection and its transmission, risks, etc -- but does not include expertise in pap smears or cervical cancer. You don't say the source of the statement you quote, but if it's accurate, I still see no reason for concern. If AGC sometimes is a step before "precancerous" changes, it's two steps away from the earliest evidence of cancer itself (CIN3 or carcinoma in situ); and that's typically a few years before cancer becomes invasive and thus dangerous.

As I said, this is outside the expertise of this forum. But my bet is that your wife's doctor's advice will be to repeat Pap smears, perhaps once a year or so, and to otherwise not be worried.
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3 months ago
Thanks doctor. They want to perform a colposcopy and an endometrial biopsy to be certain. 
The good points here are:
1. She had a clean colposcopy in Sept 2020
2. She is now showing HPV Negative 

So, as this is my last reply, I thank you for your quick replies and for the reassurance. My mom passed away from uterine cancer, so I guess I’m extra sensitive about this subject. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Thanks for the context explaining your concerns; now I better understand your concerns. I'm sorry to hear about your mom. But as you may know, uterine and cervical cancer are entirely different. Among other things, uterine cancer has nothing to do with HPV; and it also is not detected or diagnosed by Pap smear or colposcopy.

I'm glad to hear your wife's doctor has a plan; and of course she should follow his advice. But as I'm sure the doctor also would say, based on what is known so far, this is unlikely to turn out to be a serious health problem. 

That completes this thread. I hope the two discussions have been helpful. Best wishes and stay safe.
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