Cervical Cancer Screening

Table of Contents

The cervix is ​​the lower part of the uterus, where a baby grows during pregnancy. Cancer screening is done to look for cancer before you develop any symptoms. Cancers that are found early may be easier to treat.

Cervical cancer screening is usually a part of women’s health screening. There are two types of tests: the Pap test and the HPV test. For both, the doctor or nurse takes cells from the surface of the cervix. With a Pap test, the lab checks the sample for cancer cells or abnormal cells that have the potential to be cancerous later. As for an HPV test, the lab checks for HPV infection. HPV is a virus that spreads through sexual contact. Sometimes, it can cause cancer. If your screening tests are abnormal, your doctor may order more tests, such as a biopsy.

Cervical cancer screening has risks. The results can be wrong sometimes, and you may undergo unnecessary follow-up tests. There are some of its own benefits as well. Screening has been shown to reduce the number of deaths from cervical cancer. You and your doctor should discuss your risk for cervical cancer, the pros and cons of the screening tests, at what age to start getting screened, and how often to be screened.

Pap and HPV Testing – Overview

The image on the left shows healthy cervical cells, while the image on the right shows cervical cancer. Source: TheVisualMD

  • What causes cervical cancer?
  • What are Pap and HPV tests?
  • How are Pap and HPV tests done?
  • When should a woman start cervical cancer screening, and how often should she be screened?
  • What are the benefits of Pap and HPV co-testing?
  • Can the HPV test be used alone for cervical cancer screening?
  • How are Pap and HPV test results reported?
  • What follow-up tests are done if cervical cancer screening results are abnormal?
  • How are cervical abnormalities treated?
  • Do women who have been vaccinated against HPV still need to be screened for cervical cancer?
  • What are the limitations of cervical cancer screening?

What causes cervical cancer? 

Nearly all cases of cervical cancer are caused by infection with sexually transmitted oncogenic, or high-risk, types of human papillomavirus, or HPV.  There are about 12 types of high-risk HPV. Infection with this sexually transmitted virus also causes a large proportion of anal cancer; many cancers of the vagina, vulva, and penis; and some oropharyngeal cancers.

Although HPV infection is very common, most infections will be suppressed by the immune system within 1 to 2 years without causing cancer. This transient infection can cause temporary changes in cervical cells. If cervical infection with the high-risk HPV type persists, the cell changes may eventually develop into more severe precancerous lesions. If the pre-cancerous lesions are not treated, they can develop into cancer. It may take 10 to 20 years or more for persistent infection with high-risk HPV types to develop into cancer.

What is a Pap and HPV testing? 

Cervical cancer screening is an important part of women’s regular health care. This is a way to detect abnormal cervical (cervical) cells, including pre-cancerous cervical lesions, as well as early cervical cancer. Precancerous lesions and early cervical cancer can be treated very successfully. Routine cervical screening has been shown to greatly reduce both the number of new cervical cancer cases diagnosed each year and deaths from the disease.

Cervical cancer screening includes two types of screening tests: cytology-based screening, known as a Pap test or Pap smear, and an HPV test. The main purpose of screening with a Pap test is to detect abnormal cells that may develop into cancer if left untreated. A Pap test can also find non-cancerous conditions, such as infection and inflammation. This test can also find cancer cells. However, in a population that is regularly screened, a Pap test identifies the majority of abnormal cells before they become cancerous.

An HPV test is used to look for the presence of high-risk HPV types in cervical cells. This test can detect HPV infection that is causing cell abnormalities, sometimes even before the cell abnormalities are seen. Several different HPV tests have been approved for screening. Most of the tests detected high-risk HPV DNA, although one test detected high-risk HPV RNA. Some tests detect high-risk HPV and do not identify the specific type of strains that are present. Another test specifically detects infection with HPV types 16 and 18, the two types that cause most HPV-related cancers.

How is a Pap and HPV testing done?

Cervical cancer screening can be done at a medical office, clinic, or community health center. This is often done during a pelvic exam.

While a woman lies on an exam table, a health care professional inserts a device called a speculum into her vagina to widen it so that the top of the vagina and cervix can be seen. This procedure also allows the health care professional to take a sample of cervical cells. The cells are collected with a wooden or plastic scraper and/or cervical brush and then prepared for Pap analysis in one of two ways. In a conventional Pap test, a specimen (or smear) is placed on a microscope slide and a fixative is added. In an automated liquid-based Pap cytology test, cervical cells taken with a brush or other instrument are placed in a liquid preservative bottle. The slides or bottles are then sent to the laboratory for analysis.

When should a woman start cervical cancer screening, and how often should she be screened?

According to the latest guidelines, women ages, 21 to 29 should be screened with a Pap test every 3 years. Women aged 30 to 65 years should be screened every 5 years with a Pap and HPV co-testing or every 3 years with a Pap test alone.

The guidelines also note that women with certain risk factors may need to be screened more frequently or to continue screening after age 65. These risk factors include being infected with the human immunodeficiency virus (HIV), being immunosuppressed, having been exposed to diethylstilbestrol before birth, and having been treated due to precancerous cervical lesions or cervical cancer.

Women who have had a hysterectomy (surgery to remove the uterus and cervix) do not need cervical screening unless a hysterectomy is performed to treat precancerous cervical lesions or cervical cancer.

What are the benefits of Pap and HPV cotesting?

For women ages 30 or older, Pap co-testing and HPV are less likely to miss abnormalities (that is, have a lower rate of false negatives) than the Pap test alone. Therefore, a woman with a negative HPV test and a normal Pap test have a very low risk of developing serious abnormalities over the next several years. In fact, researchers have found that, when Pap co-testing and HPV are used, extending the screening interval to 5 years still allows abnormalities to be detected in time to treat while also reducing the detection of HPV infection that will resolve on its own.

Adding an HPV test to a Pap test may also improve the detection of glandular cell abnormalities, including cervical adenocarcinoma (cancer of the glandular cells of the cervix). Glandular cells are mucus-producing cells (mucus) found in the endocervical canal (the opening in the center of the cervix) or in the lining of the uterus. Glandular cell abnormalities and cervical adenocarcinoma are less common than squamous cell abnormalities and squamous cell carcinomas. There is some evidence that the Pap test detecting adenocarcinoma and glandular cell disorders is not as good as detecting squamous cell disorders and cancer.

Can HPV testing be used alone for cervical cancer screening?

On April 24, 2014, the Food and Drug Administration (FDA) approved the use of the first HPV DNA test (HPV test, Roche Molecular Systems, Inc.) as a first-line primary screening test for use alone for women 25 and older. This test detects HPV types 16 and 18 respectively and provides combined results for 12 additional high-risk HPV types.

The new approval was based on long-term findings from the ATHENA trial, a clinical trial involving more than 47,000 women. The results showed that the HPV test used in this study performed better than the Pap test at identifying women who were at risk of developing severe cervical cell abnormalities.

Greater certainty of future cervical cancer risk with an HPV test has also been shown by cohort studies of more than one million women, which found that after 3 years, women who tested negative on the HPV test had a very low risk of developing cervical cancer — around half the already low risk of women who tested negative on the Pap test

The first-line HPV test has not been included in current professional cervical cancer screening guidelines. Professional societies are developing interim guidance documents, and some medical practices may incorporate primary HPV screening.

How will Pap and HPV test results be reported?

Doctors may simply describe the Pap test results to patients as “normal” or “abnormal.” Likewise, an HPV test result can either be “positive,” meaning that the patient’s cervical cells are infected with high-risk HPV, or “negative,” indicating that a high-risk HPV type is not found. A woman may want to ask her doctor for specific information about her Pap and HPV test results and what these results mean.

Under the Bethesda System, samples that have no cell abnormalities are reported as “negative for intraepithelial lesions or malignancy.” A negative Pap test report may also note some benign (non-neoplastic) findings, such as common infection or inflammation. The Pap test results also indicate whether the specimen is satisfactory or unsatisfactory for examination.

The Bethesda system considers squamous cell and glandular cell abnormalities separately. Squamous cell abnormalities are divided into the following categories, ranging from mildest to the most severe.

Atypical squamous cells (ASC) are the most common abnormal finding in Pap tests. The Bethesda System divides this category into two groups, ASC-US and ASC-H:

  • ASC-US: atypical squamous cells of undetermined significance. Squamous cells do not appear to be completely normal, but doctors are not sure what the cell changes mean. The changes may be related to an HPV infection, but can also be caused by other factors.
  • ASC-H: atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion. The cells do not appear normal, but doctors are not sure what the cell changes mean. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions. 

Low-grade squamous intraepithelial lesions (LSILs) are considered mild abnormalities caused by HPV infection. Low grade means there is an initial change in cell size and shape. Intraepithelial refers to the layer of cells that makes up the surface of the cervix. When cells from the abnormal area are removed and examined under a microscope (in a procedure called a biopsy), LSIL is usually found to have mild cell changes that can be classified as mild dysplasia or as intraepithelial neoplasia, grade 1 cervical neoplasia (CIN-1).

High-grade intraepithelial squamous lesions (HSILs) are more severe abnormalities that have a higher likelihood of developing cancer if left untreated. High-grade means there are distinct changes in the size and shape of the abnormal (precancerous) cells and the cells look very different from normal cells. When examined under a microscope, cells from HSILs are often found to have broader changes that can be classified as moderate or severe dysplasia or as CIN-2, CIN-2/3, or CIN-3 (in order of increasing severity). HSIL microscopic exam can also reveal carcinoma in situ (CIS), which usually falls into the CIN-3 category.

Squamous cell carcinoma is cervical cancer. The abnormal squamous cells have invaded deeper into the cervix or into other tissues or organs. In a well-screened population, such as in the United States, a finding of cancer during cervical screening is very rare.

Glandular cell abnormalities describe the abnormal changes that occur in cervical glandular tissue. These abnormalities are divided into the following categories:

Atypical glandular cells (AGC), meaning glandular cells don’t appear normal, but doctors are uncertain what the cell changes mean.

Adenocarcinoma in situ endocervix (AIS), which means that cells that are very abnormal are found but have not spread beyond the cervical glandular tissue.

Adenocarcinoma includes not only cancer of the endocervical canal itself but also, in some cases, endometrial, extrauterine, and other cancers.

What follow-up tests are done if cervical cancer screening results are abnormal?

For women who perform Pap and HPV cotesting:

If a woman is found to have a normal Pap test with a positive HPV test that detects a group of high-risk HPV types, the doctor will usually ask her to come back within a year for a repeated test to see if the HPV infection persists and whether any cell changes have developed that require further testing. Or, the woman may have another HPV test that specifically looks for HPV-16 and HPV-18, the two types of HPV that cause most cervical cancers.

If one of these two types of HPV is found, a woman will usually undergo a follow-up test with a colposcopy. Colposcopy is the use of a microscope-like instrument (called a colposcope) to examine the vagina and cervix. During a colposcopy, the doctor inserts a speculum into the vagina to widen it and may apply a dilute vinegar solution to the cervix, which causes the abnormal area to turn white. The doctor then uses a colposcope (which remains outside the body) to observe the cervix. When a doctor performs a colposcopy, he or she will usually remove cells or tissue from the abnormal area to be examined under a microscope, a procedure called a biopsy.

If a woman is found to have an abnormal Pap test with a negative (normal) HPV test, follow-up tests will depend on the results of the Pap test. If the Pap test results are ASC-US, the doctor will usually ask the woman to come back in 3 to 5 years for re-screening. If the Pap test result is LSIL, the doctor may recommend a colposcopy or may ask the woman to return within a year for re-screening.

If a woman is found to have an abnormal Pap test result with a positive HPV test that detects a high-risk type of HPV, the doctor will usually ask the woman to undergo further tests with colposcopy.

For women who perform Pap and HPV test alone:

If a woman who takes the Pap test alone is found to have an ASC-US Pap test result, her doctor may have her sample tested for a high-risk HPV type or may repeat the Pap test to determine if further steps are needed. Oftentimes, the ASC-US cell changes in the cervix resolve on its own without treatment, particularly if there is no evidence of high-risk HPV infection. Doctors may prescribe estrogen cream for women with ASC-US who are approaching or going through menopause. Since ASC-US cell changes can be caused by low hormone levels, applying estrogen cream to the cervix for several weeks can usually help identify the cause.

Follow-up tests for other abnormal Pap test results will usually involve a colposcopy.

For women who perform an HPV test alone:

If a woman who has an HPV test alone tests positive for HPV type 16 or 18, she should, according to FDA instructions, undergo a colposcopy. A woman who tests negative for types 16 and 18 but positive for any of the 12 other high-risk HPV types should have a Pap test to determine if colposcopy is necessary.

How are cervical abnormalities treated?

If a cell biopsy analysis of the affected cervical area shows that the cells have CIN-2 or a more severe abnormality, further treatment may be needed depending on the woman’s age, pregnancy status, and future fertility problems. Without treatment, these cells may turn cancerous. Treatment options include the following:

  • LEEP (loop electrosurgical excision procedure), in which an electric current is passed through a thin wire loop that functions as a knife to lift tissue
  • Cryotherapy, where abnormal tissue is destroyed by freezing it
  • Laser therapy, which uses a narrow beam of intense light to destroy or remove abnormal cells
  • Conization, the removal of conical pieces of tissue using a knife, laser, or LEEP technique.

The guidelines recommend that women who have been treated for CIN-2 or more severe abnormality continue screening for at least 20 years, even if they are beyond ages 65. 

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

The answer is yes. Since the current HPV vaccines do not protect against all types of HPV that cause cervical cancer, it is important for vaccinated women to continue to have routine cervical cancer screening.

What are the limitations of cervical cancer screening?

Although the cervical cancer screening test is very effective, it is not completely accurate. In some cases, the patient may be told that she has abnormal cells when the cells are actually normal (false-positive result), or she may be told that the cells are normal when in fact there is an undetectable abnormality (false-negative result).

Cervical cancer screening has another limitation, which is due to the infectious nature of HPV. Most HPV infections are transient and only produce temporary changes in cervical cells, too frequent cervical screening can detect HPV infection or cervical cell changes that will never cause cancer. Treating abnormalities that will resolve on their own may lead to unnecessary psychological stress. Additionally, follow-up tests and treatments may be uncomfortable, and some treatments that remove cervical tissue, such as LEEP and conization, have the potential to weaken the cervix and may affect fertility or slightly increase the rate of preterm labor, depending on how much tissue is removed.

According to the 2012’s guideline, the screening intervals were intended to minimize the harm that comes from treating an abnormality that would not develop into cancer while also limiting false-negative results that would delay the diagnosis and treatment of precancerous or cancerous conditions. With this interval, if HPV infection or abnormal cells pass one screening, it is highly likely that abnormal cells will be detected in the next screening — when the disease may still be treated completely

Cervical Cancer Screening Guidelines: When You Should Get Screened

The United States Preventive Services Task Force and other organizations updated the guidelines for cervical cancer screening are based on:

  • Research showing that HPV-induced changes in cervical cells would develop slowly and often resolve on their own, especially in younger women
  • More effective screening tests
  • Research showing the dangers of over-testing and over-treatment for cervical changes that would resolve on their own

Talk to your health care provider when to start screening, how often to screen, and what screening tests to do. The age and intervals between screenings applies to most women, as long as they have normal test results. This guide does not apply to women with certain medical conditions. 

  • Women ages 21
    Women should get their first Pap test at age 21. Even if a woman is already sexually active, a Pap test is not recommended until age 21.
  • Women ages 21-29
    Women in their 20s are recommended to have a Pap test every 3 years. They should not have routine HPV testing as an HPV infection at this age tends to last only a short time before resolving on its own. However, if a woman in this age group has an abnormal Pap test result, follow-up tests may include an HPV test.

Women over 30 years may get Pap and HPV tests at the same time. This is called cotesting. This means they only need to be screened every 5 years, provided their test results are normal.

  • Ages 30-65
    It is recommended that women in this age group get a Pap test and HPV test (called co-testing) every 5 years or just a Pap test every 3 years. This longer interval still allows cell changes to be detected in time for treatment if needed but reduces treatment for cell changes that will resolve on their own.
  • Beyond ages 65 
  • Women in this age group should speak with a health care provider to learn whether screening is still necessary. If you perform regular screening and your test results are normal, your health care provider may suggest that you no longer need screening. However, if your test results are abnormal or if you do not perform regular screening, it is important to consult your doctor to get a screening.

Exceptions from the Guidelines

Depending on your medical history, your health care provider may recommend more or less frequent screenings.

More frequent screening may be recommended for women who:

  • Are HIV positive
  • Have a weak immune system
  • Are exposed to a medicine called diethylstilbestrol (DES) before birth. This is a type of medicine that is prescribed to pregnant women
  • Have had a recent abnormal Pap test or biopsy result 
  • Have had cervical cancer

Screening is not required for women who:

  • Have had a hysterectomy for reasons not related to cancer or cervical cell changes. However, if your hysterectomy is related to cervical cancer, talk to your doctor to learn about the follow-up treatment you need.

Cervical Cancer Test

Several screening tests are used because they have been shown to detect cancer early and reduce the chance of dying from cervical cancer. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that the use of this test reduces the risk of dying from cancer.

Scientists study screening tests to determine which test has the lowest risk and biggest benefit. Cancer screening tests are also intended to show whether early detection (finding cancer before it causes symptoms) reduces a person’s chances of dying from the disease. For some types of cancer, the chances of recovery are better if the disease is found and treated early.

Studies show that screening for cervical cancer helps reduce the number of deaths from the disease

Routine screening for women between the ages of 21 and 65 with a Pap test reduces the chance of dying from cervical cancer.

The Pap test is usually used to screen for cervical cancer.

A Pap test is a procedure to collect cells from the surface of the cervix and vagina. A cotton swab, brush, or small wooden stick is used to gently remove cells from the cervix and vagina. The cells are looked at under a microscope to see if they are abnormal. This procedure is also called a Pap smear. A new method of capturing and viewing cells has been developed in which the cells are placed into a liquid before being placed into a slide. It is not known whether the new method will work better than the standard method to reduce the number of cervical cancer deaths.

Pap test. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to remove cells from the cervix. The cells are examined under a microscope for signs of disease.

After a certain positive Pap test result, an HPV test can be done.

An HPV test is a laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are taken from the cervix and DNA or RNA from infected cells caused by a type of human papillomavirus linked to cervical cancer. This test may be done using a cell sample taken during the Pap test. This test may also be done if the Pap test results show certain abnormal cervical cells. When the HPV test and Pap test are performed using cells from a sample taken during the Pap test, it is called a Pap / HPV co-testing

An HPV test can be done with or without a Pap test for cervical cancer screening.

Women ages 30 and older who perform both a Pap test and an HPV test every 5 years are found to have more cervical changes that may cause cancer compared to screening with a Pap test alone. Screening with Pap tests and HPV tests lower the number of cervical cancer cases.

An HPV DNA test may be used without a Pap test to screen for cervical cancer in women ages 25 years and older

Risks of Cervical Cancer Screening 

Kanker Serviks dan HPV. Sumber: scientificanimations.com

It may be difficult to make the decision to perform the screening exam — considering that not all screening tests are helpful and most of them are risky. Before doing any screening tests, you may want to discuss the details with your doctor. It is important to know the risk of the test and whether it has been shown to reduce the risk of dying from cancer.

The risks for cervical cancer screening include the following:

Unnecessary follow-up tests may be performed

In women younger than 21, screening with a Pap test may show changes in cervical cells that are not cancerous. This can lead to unnecessary follow-up tests and treatment. Women in this age group have a very low risk of cervical cancer and it is likely that the abnormal cells will go away on their own.

False negative test results can occur.

The results of the screening tests may appear normal even though cervical cancer is found. Women who receive a false-negative test result (one that shows no cancer is found, but in fact there is) may delay seeking medical care even if they have symptoms.

False positive test results may occur.

The test results may appear abnormal even though no cancer is found. Additionally, some abnormal cells in the cervix never become cancerous. When a Pap test shows a false positive (one that indicates cancer is found when it is not), it may cause anxiety and is usually followed by more tests and procedures (such as colposcopy, cryotherapy, or LEEP), which also have risks. The long-term effects of this procedure on fertility and pregnancy are unknown.

An HPV test finds many infections that will not cause cervical dysplasia or cervical cancer, especially in women younger than 30.

When both Pap test and HPV test are performed, false positive test results tend to be more common.

Your doctor will tell you about your risk of cervical cancer and your needs for screening tests.

Studies show that the number of cervical cancer cases and deaths from cervical cancer is greatly reduced by a Pap test screening. Many doctors recommend for women to have a Pap every year. The new study shows that after a woman has had a Pap test and the results show no signs of abnormal cells, the Pap test may be repeated every 2 to 3 years.

A Pap test is not a useful screening test for cervical cancer in women who:

  • Are younger than 21 
  • Have had a total hysterectomy (surgery to remove the uterus and cervix) for non-cancerous conditions.
  • Are 65 or older and have a Pap test result that shows no abnormal cells. These women are very unlikely to have an abnormal Pap test result in the future.

The decision about how often to do a Pap test is best recommended by your doctor.

Understanding Cervical Changes: The Next Step After Abnormal Screening Tests

Most women who have an abnormal cervical screening test result do not have cervical cancer. Most have early, monitorable cell changes, as they often go away on their own – or are treated early, to prevent problems later. It is important to have follow-up visits, tests, or treatments suggested by the doctor.

Pap Test Results 

The Pap test results show whether cervical cells are normal or abnormal. A Pap test can also be unsatisfactory. Next steps may include:

  • Normal Pap test results: Your healthcare provider may usually recommend another screening test within 3 to 5 years. A normal test result can also be called a negative test result.
  • Unsatisfactory Pap test results: Your healthcare provider may ask you to come for another Pap test. The laboratory sample may not have enough cells, or the cells may have clotted or hidden in the blood or mucus.
  • Abnormal Pap test result: Your healthcare provider may recommend more tests or treatments for this finding: ASC-US, AGC, LSIL, ASC-H, HSIL, or AIS. These changes in cervical cells are listed in the table below from mild to more severe. These changes can be referred to as dysplasia, neoplasia, or abnormal, but not cancerous and precancerous cells. An abnormal test result can also be called a positive test result

Your pap test results usually come back from the laboratory within 1 to 3 weeks. If you do not hear from your healthcare provider, call and ask about your test results. Ask about any follow-up visits or tests you may need.

Pap Test ResultWhat They Mean and Possible Next Steps
ASC-USAtypical Squamous Cells of Undetermined Significance ASC-US is the most common abnormal Pap test finding. This means that some cells do not appear completely normal, but it is unclear whether the changes are caused by HPV infection. Other things may cause cells to look abnormal, such as irritation, some infections, such as yeast infections, growths, such as polyps or benign cysts (not cancerous), and hormonal changes that occur during pregnancy or menopause. Although these things may make cervical cells look abnormal, they are not related to cancer. Possible next steps: An HPV test may usually be performed, or a Pap test may be repeated in 12 months.
AGCAtypical Glandular Cells (Atypical Gland Cells)AGC means that some glandular cells that look abnormal are found. More tests are usually recommended. Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.
LSILLow-Grade Squamous Intraepithelial Lesions LSIL is sometimes called mild dysplasia. This can also be called CIN 1. LSIL means that there is a low-grade change. Changes in LSIL are usually caused by HPV infection. Although the changes may go away on their own, further tests are usually done to see if there are more severe changes that need to be treated. Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.
ASC-HAtypical Squamous Cells, Cannot Exclude HSILASC-H means that some abnormal squamous cells are found which may be high-grade squamous intraepithelial lesions (HSIL) — although this is uncertain. More testing is recommended. Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.
HSILHigh-Grade Squamous Intraepithelial Lesions HSIL is sometimes called moderate or severe dysplasia. This can also be called CIN 2, CIN 2/3, or CIN 3. HSIL means that there are more serious changes than LSIL, in the cells of the cervix. These changes are caused by HPV and can turn into cervical cancer if left untreated. Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.
AISAdenocarcinoma In SituAIS means advanced lesions (areas of abnormal growth) are found in cervical glandular tissue. AIS lesions may become cancer (cervical adenocarcinoma) if left untreated. Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.
Cervical cancer cellsSometimes cervical cancer cells (squamous cell carcinoma or adenocarcinoma) are found. However, for women who get regular screening, it is very rare for cancer cells to be found on a Pap test.Possible next steps: Colposcopy and biopsy as described in the Follow-up Tests section.

These images show how cervical cells that have a long-term infection with high-risk HPV may change over time and become abnormal. Abnormal cervical cells may also return to normal even without treatment, especially in younger women. LSIL and HSIL are two types of abnormal changes in cervical squamous cells.

More about Biopsy Findings and CIN

CIN stands for cervical intraepithelial neoplasia. This means that abnormal cells are found on the surface of the cervix. CIN is usually caused by certain types of human papillomavirus (HPV) and is discovered when a cervical biopsy is performed. CIN is not cancer, but it can become cancerous and spread to nearby normal tissue if left untreated. It is graded on a scale of 1 to 3, based on how abnormal the cells look under a microscope and how much cervical tissue is affected. For example, CIN 1 has slightly abnormal cells and is less likely to become cancerous than CIN 2 or CIN 3.

Cotesting Results

If you have both a Pap test and an HPV test, this is called co-testing. The guidelines suggest that routine Pap and HPV co-testing be restricted to women ages 30 and older. However, an HPV test may be performed in women of any age after unclear Pap test findings and to help your health care provider determine if further evaluation is required.

The cotesting results usually return from the laboratory within 1-3 weeks. You may receive letters or phone calls from health care providers. If you do not hear from them, call and ask about your test results. Ask about any follow-up visits or tests you may need.

Your doctor may tell you how the Pap test and HPV test work. He or she may take the time to help you understand the next step and why you need to take it.

Both Test Results are Normal

If both your Pap and your HPV test results are normal, your health care provider may tell you that you have to wait 5 years before your next test (Pap and HPV tests)

One Normal Test Result and One Abnormal Test Result

  • The Pap test results are normal and the HPV test results are not normal. Your health care provider may recommend that you return for a repeated test in 12 months or have a different HPV test.
  • Abnormal Pap test results and normal HPV test results
    • For abnormal ASC-US Pap test results: Most women are advised to have another Pap and HPV test within 3-5 years.
    • For other abnormal Pap test results: Your health care provider may recommend you to have a colposcopy —  which is performed to take a closer look at your cervix and perform a biopsy. Based on the colposcopy findings, your health care provider will decide whether further tests or treatment are required

Learn more about Pap Test Results and Follow Up Test.

Both Tests are Abnormal

When both Pap test results and HPV test results are abnormal, you may need further tests and possible treatment. The first step is usually a colposcopy. Colposcopy allows your health care provider to take a closer look at your cervix and take a sample of cervical cells which will then be examined by a pathologist; this procedure is called a biopsy. The sample is then examined under a microscope for signs of disease. Based on the results, your health care provider will decide whether further testing or treatment is needed.

About HPV Test Only for Cervical Cancer Screening

Recent research findings suggest that the HPV test alone is very effective for cervical cancer screening. The FDA has recently approved this use. In the future, a cervical exam may only need an HPV test, not a co-testing. Talk to your healthcare provider to learn more.

Follow-up Tests and Procedures

It should be noted when most women with abnormal cervical screening test results do not develop cancer. However, if you get any abnormal test results, it is important to have the tests and / or follow-up treatment recommended by your doctor. The next steps and treatments you may take are listed in this section to help you learn more.

Depending on your test results, the next steps may include:

  • Pap Test
    Some women may need to return for another Pap test
  • HPV Test
    An HPV test may be recommended.
  • Estrogen Cream
    If you have ASC-US and are approaching or going through menopause, your healthcare provider may prescribe an estrogen cream. If the cell changes are caused by low hormone levels, applying estrogen cream may make the cell changes disappear.
  • Colposcopy
    Your doctor will examine your cervix using a colposcope and perform a biopsy. 
    • During a colposcopy, your doctor will insert a speculum to gently open the vagina and look at the cervix. The diluted white vinegar is put on the cervix, causing the abnormal area to turn white. Then, your doctor places an instrument called a colposcope close to your vagina. It has a bright light and a magnifying lens and allows your doctor to see your cervix more closely.
    • A colposcopy usually includes a biopsy. A biopsy is performed to examine cells or tissues under a microscope for signs of disease. In addition to removing the sample for further testing, some types of biopsy may be used as a treatment to remove abnormal cervical tissue or lesions.
  • Biopsy
    Types of cervical biopsy include:
    • Biopsi kerucut (atau konisasi): sampel jaringan serviks yang berbentuk kerucut dihilangkan
    • Endocervical curettage: a curette procedure where the cells are scraped from the lining of the cervical canal 
    • Punch biopsy: a small piece of cervical tissue is removed
    • Cone (or conization) biopsy: a cone-shaped sample of cervical tissue is removed

Talk to your doctor to learn what to expect during and after your procedure. Some women may experience bleeding and/or vaginal discharge after a biopsy. Others may experience pain like menstrual cramps. The list of questions below may help you to learn more. 

Questions to Ask Before The Test or Procedure 

  • What is the purpose of this test or procedure? What will the results tell you?
  • What will happen during the procedure? How long will it take?
  • Should I limit activities after the procedure? For how long?
  • What problems or side effects will require me to call you after the procedure?

Treatments for Cervical Cell Changes

Some abnormal cervical changes need to be removed so they do not turn into cancer. Your doctor will talk to you about the recommended treatments for you and why. The questions in this section may help you talk with your health care provider to learn more.

General Treatment Methods

  • Cold knife conization
    During this type of treatment, a scalpel is used to remove the abnormal tissue. This procedure is performed in a hospital and requires general anesthesia.
  • Cryotherapy. This is a procedure that involves extreme cold to freeze and destroy abnormal tissue in the cervix. This procedure may be performed in the doctor’s office. It only takes a few minutes and usually does not require anesthesia.
  • Laser therapy
    During laser therapy, a laser (an intense beam of light) is used to destroy the abnormal tissue. This procedure may be performed in a hospital and require general anesthesia.
  • LEEP (loop electrosurgical excision procedure) During this procedure, a wire loop heated by an electric current is used to remove abnormal tissue. A local anesthetic is used to numb the area. Doctors usually perform this procedure in a practice setting. It only takes a few minutes, and you will remain awake during the procedure.

Questions to Ask Before Treatment

  • What are the possible treatments for my condition? What are the advantages and disadvantages of each treatment?
  • What treatments do you recommend for me, and why?
  • What will happen during treatment?
  • What are the possible risks of this treatment? How will this treatment affect future pregnancies?
  • How long is the procedure? Will general or local anesthesia be required?
  • What side effects might I experience from this procedure? How long do these side effects last?
  • Are there any activities I should avoid after the procedure?

Source: StoryMD

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