Understanding Cervical Changes
Understanding Cervical Changes
Cervical Changes
A Health Guide
Health care providers: Here’s a handout that can help your patients access an online version of
this booklet: www.cancer.gov/ucc-flyer.
b
Table of Contents
Use this guide to learn more and talk with
your health care provider about:
Introduction ii
HPV Infection 1
Cervical Cancer Screening 2
Screening Guidelines: When to Get Screened 4
HPV Test Results 6
Pap Test Results 7
Follow-up Tests and Procedures 9
Treatments for High-Grade Cervical Cell Changes 12
HPV Vaccination 14
Related Resources 15
i
Introduction
You may be reading this booklet because you had an abnormal cervical cancer
screening test. Although it’s common to feel uneasy, you should know that most
women who have abnormal cervical screening test results do not have cervical cancer.
Most have early cell changes that can be monitored (since they often go away on their
own) or treated early (to prevent problems later). So, get the follow-up visits, tests, or
treatment that your health care provider advises.
Scientific advances have helped us learn much more about how cervical cancer
develops, as well as how and when to screen women. However, these advances have
also added a layer of complexity for health care providers and women. This booklet
helps you talk with your health care provider and make informed decisions to prevent
cervical cancer.
Good news about
preventing cervical cancer
We know what causes cervical cancer.
Nearly all cervical cancer is caused by a virus called HPV (human papillomavirus).
ii
HPV Infection
“My doctor told me that long-lasting
infections with certain HPV types can
cause cancer in the cervix, vagina,
and vulva, as well as in the anus,
penis, and parts of the mouth.”
● Low-risk HPV types can cause genital warts. These are warts on the external and internal
sex organs and glands. Genital warts do not turn into cancer.
Smoking may increase the risk that an HPV infection will persist and develop into cervical
cancer. So if you smoke and have an abnormal Pap or HPV test result, it is especially
important to stop smoking.
HPV infections are common. Most people who are sexually active will have an HPV
infection at some point and never know it. HPV infections can be spread through skin-to-skin
contact, including vaginal, anal, and oral sex. Although condoms can lower the risk of an
HPV infection, they do not protect against them completely.
Most HPV infections, even with high-risk types, go away on their own without
causing problems. They are fought off by the body’s immune system. However, sometimes
infections with high-risk HPV types do not go away. When a high-risk HPV infection of
cervical cells lasts many years, the cells can become abnormal. These changes can get worse
over time and may become cervical cancer. Although there is currently no way to treat an
HPV infection, cervical cancer can be prevented by detecting and removing abnormal cervical
cells before they become cancer.
1
Cervical Cancer Screening
The HPV test checks cells for infection with high-risk HPV types that can cause cancer.
The Pap test (also called a Pap smear or cervical cytology) collects cervical cells and looks at
them for changes caused by HPV that may—if left untreated—turn into cervical cancer. It can
also detect cervical cancer cells. A Pap test sometimes finds conditions that are not cancer,
such as infection or inflammation.
The HPV/Pap cotest uses a Pap test and HPV test together to check for both high-risk HPV
and cervical cell changes.
● The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) by calling
1-800-232-4636 or visiting www.cdc.gov. NBCCEDP is a service of the CDC that provides
low-income, uninsured, and underserved women access to cervical cancer screening and
diagnostic services.
2
What to expect Questions to ask
Cervical cancer screening is usually done during
a pelvic exam, which takes only a few minutes. Before your exam
During this exam, you lie on your back on an Ask your health care provider:
exam table, bend your knees, and put your feet ● What will happen during the exam?
into supports at the end of the table. The health ● What tests will I have?
care provider uses a speculum to gently open your ● What is the purpose of these tests?
vagina in order to see the cervix. A soft, narrow ● Will I have any discomfort?
brush or tiny spatula is used to collect a small
sample of cells from your cervix. Your health care provider
may ask you:
The sample of cervical cells is sent to the lab and ● What was the start date of your
checked for abnormal cervical cells. The same last menstrual period?
sample can also be checked for HPV, with an HPV ● When did you have your last
test. When both a Pap test and an HPV test are cervical cancer screening test?
done, this is called HPV/Pap cotest. ● What were your test results?
A pelvic exam may include more than taking ● Have you ever had abnormal
samples for an HPV and/or Pap test. Your health test results?
care provider may also check the size, shape, and ● Have you ever had treatment for
position of the uterus and ovaries and feel for any abnormal cells on your cervix?
lumps or cysts. The rectum may also be checked After your exam
for lumps or abnormal areas. Most health care Ask your health care provider:
providers will tell you what to expect at each step ● When will I get my test results?
of the exam, so you will be at ease. You may also
● How will I get these results
ask to be tested for other sexually transmitted
(e.g., by mail, online, or phone call)?
infections (STIs).
● What phone number should I call
if I do not get my test results?
● When I get my results, will they
explain what I should do next?
The female
reproductive system
The cervix is part of the female
reproductive system. It’s the
lower, narrow end of the uterus,
which leads to the vagina. The
cervix opens during childbirth
to allow the baby to pass
through.
3
Screening Guidelines:
When to Get Screened
“Talk with your family and friends
about screening for cervical cancer.
Over 4,000 women in the United
States die of cervical cancer every
year. Cervical cancer is easy to
prevent with routine screening.”
● HPV-caused changes in cervical cells happen slowly and often go away on their own,
especially in younger women
● the harms of overtesting and overtreatment for cervical cell changes that would have gone
away on their own
4
Age 21-29 years Exceptions to
Get your first Pap test at age 21 and
have Pap testing every 3 years. Even the guidelines
if you are already sexually active,
Talk with your health care provider about whether
Pap tests are not recommended
you need a personalized screening plan.
until age 21, according to USPSTF
recommendations. Certain health conditions
More frequent screening may be recommended
Age 30-65 years if you:
Get an HPV test every 5 years, an ● are HIV positive
HPV/Pap cotest every 5 years, or a ● have a weakened immune system
Pap test every 3 years, according to
USPSTF recommendations. ● were exposed before birth to a medicine
called diethylstilbestrol (DES), which was
The American Cancer Society prescribed to some pregnant women
recommends HPV tests every 5 years, through the mid-1970s
starting at age 25. Screening with an ● had a recent abnormal cervical screening
HPV/Pap cotest every 5 years or a Pap test or biopsy result
test every 3 years is also acceptable.
● have had cervical cancer
5
HPV Test Results
HPV test results show if high-risk HPV types were found in cervical cells. An HPV test will
come back as a positive test result or a negative test result:
● Positive HPV test result: High-risk HPV was found. Your health care provider will
recommend follow-up steps you need to take based on your specific test result, such as
those listed in the Follow-up Tests and Procedures section on page 9.
● Negative HPV test result: High-risk HPV was not found. You need to be tested again in
5 years. However, your health care provider may advise you to come back sooner if you had
abnormal results in the past.
HPV test results usually come back from the lab in about 1–3 weeks. If you don’t hear from
your health care provider, call and ask for your test results. Make sure you get any follow-up
tests or procedures that are recommended.
There is no way to tell whether a newly positive HPV test result is a sign of a new infection
or a reactivation of an old infection. Researchers don’t know whether a reactivated HPV
infection has the same risk of causing cervical cell changes or cervical cancer as a new HPV
infection.
6
Pap Test Results
Pap test results show if cervical cells are normal or abnormal. A Pap test may also come back
as unsatisfactory.
● Normal Pap test result: A normal Pap test result may also be called a negative test
result or negative for intraepithelial lesion or malignancy (NILM). If only the Pap test
was done, you should have another Pap test in 3 years. If the Pap test was done together
with an HPV test (this is called a Pap/HPV cotest), you should have this test again in 5
years. You may need to come back sooner if you have had abnormal results in the past..
● Abnormal Pap test result: An abnormal test result may also be called a positive test
result. An abnormal Pap test result does not mean you have cervical cancer. Possible
abnormal findings on a Pap test include ASC-US, AGC, LSIL, ASC-H, HSIL, AIS, or
cervical cancer. Your health care provider will recommend follow-up steps you need to
take based on your specific test result and your past test results.
● Unsatisfactory Pap test result: The lab sample may not have had enough cells, or the
cells may have been clumped together or hidden by blood or mucus. Your health care
provider will usually ask you to come in for another screening test in 2 to 4 months.
Pap test results usually come back from the lab in about 1–3 weeks. If you don’t hear from
your health care provider, call and ask for your test results. Make sure you receive your test
results and understand any follow-up visits or treatments that you need.
7
Pap test results and possible next steps
ASC-US Atypical Squamous Cells of Undetermined Significance (ASC-US) is the most
Atypical common abnormal Pap test finding. It means some cells don’t look completely
Squamous Cells normal, but it’s not clear if the changes are caused by HPV infection. Other things
of Undetermined can cause cells to look abnormal, including irritation, some infections (such
Significance as a yeast infection), growths (such as polyps in the uterus), and changes in
hormones that occur during pregnancy or menopause. Although these things
may make cervical cells look abnormal, they are not related to cancer. Your health
care provider will usually do an HPV test to see if the changes may be caused by an
HPV infection. If the HPV test is negative, estrogen cream may be prescribed to
see if the cell changes are caused by low hormone levels. If the HPV test is positive,
you may need additional follow-up tests as explained on page 9.
AGC Atypical Glandular Cells (AGC) means some glandular cells were found that do
Atypical Glandular not look normal. This can be a sign of a more serious problem up inside the uterus,
Cells so your health care provider will likely ask you to come back for a colposcopy, as
explained on page 10.
LSIL Low-Grade Squamous Intraepithelial Lesions (LSIL) means there are low-grade
Low-Grade changes that are usually caused by an HPV infection. Your health care provider will
Squamous likely ask you to come back for more testing, as explained on page 10, to make
Intraepithelial sure that there are not more serious (high-grade) changes.
Lesions
ASC-H Atypical Squamous Cells, cannot exclude HSIL (ASC-H) means some abnormal
Atypical Squamous squamous cells were found that may be a high-grade squamous intraepithelial lesion
Cells, Cannot (HSIL), although it’s not certain. Your health care provider will likely ask you to
Exclude HSIL come back for a colposcopy, as explained on page 10.
HSIL High-Grade Squamous Intraepithelial Lesions (HSIL) means there are moderately
High-Grade or severely abnormal cervical cells that could become cancer in the future if not
Squamous treated. Some lesions may be called precancer. Your health care provider will likely
Intraepithelial ask you to come back for a colposcopy, as explained on page 10.
Lesions
AIS Adenocarcinoma in situ (AIS) means an advanced lesion (area of abnormal tissue)
Adenocarcinoma was found in the glandular tissue of the cervix. AIS lesions may become cancer
In Situ (cervical adenocarcinoma) if not treated. Your health care provider will likely ask
you to come back for a colposcopy and biopsy, as explained on page 10.
8
Follow-up Tests and Procedures
Keep in mind that most women with abnormal cervical screening test results do not have
cancer. However, if you have an abnormal test result, it’s important to get the follow-up care
that is recommended. Next steps are based on your chances of developing severe cervical cell
changes that could become cervical cancer, if not treated.
Follow-up care
In addition to your current test result, your health care provider will consider factors such as
these when recommending follow-up care:
The goal is to detect and treat severe cervical cell changes that could develop into cervical
cancer while also decreasing testing and treatment for less severe conditions (low-grade
cervical cell changes).
9
What to expect during a colposcopy
A colposcopy is a procedure that allows the cervix to be examined. During this procedure,
your health care provider inserts a speculum to gently open the vagina and view the cervix.
A vinegar solution will be applied to the cervix to help show abnormal areas. Your health care
provider then places an instrument called a colposcope close to the vagina. It has a bright
light and a magnifying lens and allows your health care provider to look closely at your
cervix.
During a colposcopy, a cervical biopsy is usually done. This is a procedure in which a sample
of abnormal tissue is removed from the cervix so that the cervical cells can be studied under a
microscope.
Talk with your health care provider to learn what to expect during and after your biopsy
procedure. Some women have bleeding and/or discharge after a biopsy. Others have pain
that feels like cramps during menstruation. Biopsy samples are checked by a pathologist for
cervical intraepithelial neoplasia (CIN).
CIN is graded on a scale of 1 to 3, based on how abnormal the cells look under a microscope
and how much of the cervical tissue is affected. LSIL (also called low-grade squamous
intraepithelial lesion, or mild dysplasia) seen on a Pap test is generally CIN 1. HSIL (also
called high-grade squamous intraepithelial lesion, or moderate or severe dysplasia) seen on a
Pap test can be CIN 2, CIN2/3, or CIN 3.
● CIN 1 changes are mild, or low grade. They usually go away on their own and do not
require treatment.
● CIN 2 changes are moderate and are typically treated by removing the abnormal cells.
However, CIN 2 can sometimes go away on its own. Some women, after consulting with
their health care provider, may decide to have a colposcopy with a biopsy every 6 months.
CIN 2 must be treated if it progresses to CIN 3 or does not go away in 1 to 2 years.
● CIN 3 changes are severely abnormal. Although CIN 3 is not cancer, it may become cancer
and spread to nearby normal tissue if not treated. Unless you are pregnant, it should be
treated right away.
10
Pregnancy and treatment of high-grade cervical cell changes
If you are pregnant or plan to become pregnant and are found to have high-grade cervical cell
changes, your health care provider will talk with you about treatments that are recommended
for you and the timing of these procedures. Depending on your specific diagnosis, you may
be treated postpartum, or after delivery.
11
Treatments for High-Grade
Cervical Cell Changes
These treatments are used when a woman has high-grade cervical cell changes that have a
high risk of developing into cancer. Your health care provider will talk with you about which
treatment is recommended for you and why. The questions on the next page can help you
talk with your health care provider to learn more.
● Cold knife conization (also called cold knife cone biopsy): A scalpel or laser knife is used
to remove a cone-shaped section of abnormal tissue. This procedure is done at the hospital
and requires general anesthesia.
● LEEP (loop electrosurgical excision procedure): A thin wire loop, through which an
electrical current is passed, is used to remove abnormal tissue. Local anesthesia is used to
numb the area. This procedure is done in your health care provider’s office. It takes only a
few minutes, and you will be awake during the procedure.
● Cryotherapy: A special cold probe is used to destroy abnormal tissue by freezing it. This
procedure is done in your health care provider’s office. It takes only a few minutes and
usually does not require anesthesia.
● Laser therapy: A laser (narrow beam of intense light) is used to destroy abnormal tissue.
This procedure is done at the hospital and general anesthesia is used.
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Questions to ask before treatment
● What are the possible treatments for the condition that I have? _______________
____________________________________________________________________
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● Which treatment do you recommend for me, and why? ______________________
____________________________________________________________________
____________________________________________________________________
● What are the advantages and disadvantages of this treatment? ________________
____________________________________________________________________
____________________________________________________________________
● What will happen during the treatment? ___________________________________
____________________________________________________________________
____________________________________________________________________
● What are the possible risks of this treatment? ______________________________
____________________________________________________________________
____________________________________________________________________
● How might this treatment affect a future pregnancy? ________________________
____________________________________________________________________
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● How long will the procedure take? _______________________________________
____________________________________________________________________
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● Will general or local anesthesia be needed? ________________________________
____________________________________________________________________
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● What side effects might I have from this procedure? ________________________
____________________________________________________________________
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● How long might these side effects last? ___________________________________
____________________________________________________________________
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● Are there any activities that I should avoid after the procedure? _______________
____________________________________________________________________
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13
HPV Vaccination
Human papillomavirus (HPV) vaccination protects against infection with HPV types that cause:
● nearly all cases of cervical cancer
● most cases of anal cancer and many cases of penile cancer, vaginal cancer, vulvar
cancer, and oropharyngeal cancer (cancer in the middle of the throat, including the
tonsils and the back of the tongue).
HPV vaccination also protects against infection by the HPV types that cause most warts on or
around the genitals and anus.
Answers to
commonly asked questions
At what age should children get the HPV vaccine?
Girls and boys should start the HPV vaccine series at age 11 or 12; it may be started at
age 9.
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Can the HPV vaccine be given at older ages?
Yes, the vaccine can be given to adults between the ages of 27 and 45 who didn’t
receive all vaccine doses earlier. Adults in this age group benefit less from the vaccine
because they are more likely to have been exposed to HPV already. Therefore,
vaccination is not routinely recommended for people in this age group. If you are
concerned that you are at risk for a new HPV infection, talk with your health care
provider about whether HPV vaccination may be right for you.
Related Resources
National Cancer Institute
The National Cancer Institute has information to help you learn more about cervical cancer
prevention, screening, and treatment:
● Visit our cervical cancer home page: www.cancer.gov/types/cervical
● Contact a cancer information specialist: www.cancer.gov/contact or call 1-800-422-6237
(1-800-4-CANCER)
● Access other formats (PDF, e-book, and Kindle) of this guide: www.cancer.gov/ucc-guide
● View this online resource: Next Steps after an Abnormal Cervical Cancer Screening
Test: Understanding HPV and Pap Test Results at www.cancer.gov/ucc