Question: Hi. I had a question about some test results I received yesterday. (The doctor was very abrupt and I was a little nervous about asking additional questions.) Brief history: 24 y/o generally healthy female, no children, have never been pregnant. I have the following Pap smear results, starting with first annual Pap at age 21. Year 1: LSIL with HPV, no further testing. Year 2: LSIL with HPV, HPV shown to be highly cancerous strain, colposcopy showed normal tissue. Year 3 (this year): LSIL cannot exclude HSIL, with HPV, colposcopy repeated.

At this year's colposcopy they saw a lesion after the vinegar staining and so they biopsied around that area and then performed endocervical curettage. The samples taken from the external cervix came back normal, but the endocervical sample came back consistent with the Pap results: low grade lesions... but insufficient sample size to exclude HSIL. So they repeated the endocervical curettage but took a larger sample and scheduled me for a results discussion in two weeks. They said since I am so young, this finding is quite unusual, and there are no guidelines for what to do with me, so they are not sure what the next steps are/will be.

To make matters more complicated, I am a DES granddaughter (mother was conceived while grandmother was taking the synthetic estrogen drug DES, now shown to increase reproductive cancers in female offspring). My doctor is convinced that the epigenetic effects associated with DES exposure have nothing to do with any of my results, despite the fact that my mother had to have cryotherapy around my age for abnormal cervical cells thought to related to her prenatal DES exposure, since she was/is HPV negative. As I understand it, the DES-related cancers manifest in different cell types than the HPV-related cancers, but is this element of my medical history truly not a concern? She said we wouldn't be concerned about DES history until we find a mass in my vagina but that seems WAY farther down the chain in terms of cancer development than I am comfortable with... and they identified my mother's related abnormal cervical cells far before that point, anyway.

I guess my general question is what do I make of all this? Is it significant that the external cervix is normal, while the internal cervix is abnormal? What does it mean that I have never had a normal Pap smear and now my results are sliding into high lesion territory? Should I press the issue regarding the DES history? How nervous should I reasonably be for these results... I am living across the country from my family, with whom I'm very close, so should someone fly out to be with me at that appointment?