By the way, doctor: My Pap tests show insufficient cells. What does that mean?

Q. For two years in a row, the lab that handles my Pap smears has reported "insufficient cell count." My doctor says it's nothing to worry about, but my health insurance company considers these "abnormal" Paps and has put me in a higher-risk category because of it. Should I be concerned?

A. When lab pathologists evaluate Pap tests for abnormal cells, the goals are to identify cancer that should be removed and precancerous conditions that should be followed closely to watch for any changes. Sometimes the results are unclear because the lab sample doesn't contain enough cells to evaluate ("insufficient cell count") — or because the cells are obscured by inflammation, mucus, or blood from a heavy menstrual period. In these cases, the Pap test is not necessarily abnormal; the specimen is simply inadequate to make any determination.

An insufficient cell count can occur if a clinician has difficulty retrieving enough cells or if you have used a douche in the day or two before a Pap test. In such cases, the Pap test can simply be repeated. I usually try to do this within two to four months. But if a woman has no history of cervical cancer or precancerous changes and her Pap test results have all been normal in the past, it's okay to wait a year.

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