What You Should Know About Cervical Cancer Screening

Cervical screening makes it possible to find and treat early-stage cervical cancer. Doctors use two main tests to detect changes in the cells of the cervix and identify viruses involved.

Cervical cancer develops in the narrow part of the lower end of the uterus and merges with the upper part of the vagina. Doctors find the human papillomavirus (HPV) in about 99% of cervical cancers, but most cases of HPV do not become cancerous. Having HPV is the most important risk factor for cervical cancer.

The Pap test and HPV test are the main components of cervical cancer screening.

According to the National Cancer Institute, regular screening reduces the risk of developing or dying from cervical cancer by 80%.

What Are Screening Tests?

Cervical cancer screening may involve using the HPV test or Pap test. The doctor may also perform a physical examination of the pelvis.

  • Pap Smear Test: A healthcare professional uses a tool they call a speculum to widen the vagina to access the cervix. They then collect a sample of cells from the cervix. They send the cell sample to a lab to be examined under a microscope. Lab technicians look at the appearance of the cells. If it looks abnormal, it may be a sign that cervical cancer is in the early stages of development known as precancer. Early treatment can correct these cellular changes and prevent cervical cancer from starting.
  • HPV Testing: A doctor will use HPV testing to detect the virus behind many abnormal cellular changes that can lead to cervical cancer. However, HPV DNA testing can identify a few infections that experts do not link to cancer. A positive HPV test usually does not mean that a person will go on to develop cancer.

What are the Screening Criteria and Recommendations?

The American Cancer Society provides guidelines for regular cervical cancer screenings in women of all ages:

  • Ages 21-29: A woman between these ages should have a Pap test at 3-year intervals. HPV testing is not required at this stage. However, if the results are abnormal, the doctor may follow up with a Pap test with an HPV test.
  • 30-65 years: Doctors recommend the following for people this age:
    • Joint test every 5 years or a combination of both tests
    • Pap test every 3 years
  • Over 65: Women who have had regular screening in the last 10 years and have had clear results from start to finish can stop screening at this age.

However, if a test done within the past 20 years shows signs of serious precancer, screening should continue until 20 years after that precancerous finding.

Women at high risk of cervical cancer:

Women who have had the HPV vaccine should still be screened for cervical cancer.

Those at high risk of cervical cancer should have more frequent testing. This includes women who are immunocompromised, such as those with HIV or a previous organ transplant. People may also be at increased risk if they have been exposed to diethylstilbestrol (DES), a synthetic form of estrogen, before birth.

After a total hysterectomy, which involves removal of the uterus and cervix, screening is no longer necessary. However, if a doctor has performed a hysterectomy to treat cancer, they should continue screening.

A person with current or previous cervical cancer or precancer will have their own screening and treatment plans, as well as those with HIV infection.

A false positive result not only causes stress, but can also lead to unnecessary procedures that can have long-term risks. For this reason, doctors do not recommend annual screenings.

What Do the Results Mean?

Cervical screening test results may be normal, indeterminate, or abnormal.

  • Normal: There was no change in the cells of the cervix.
  • Uncertain: The cells appear abnormal and the pathologist was unable to identify changes that could indicate precancerous. These abnormal cells may be related to HPV, infection, pregnancy or life changes.
  • Abnormal: Lab technicians have found changes in cervical cells. Abnormal cells do not always indicate cancer. The doctor will usually order more tests to see if the changes have turned into cancer.

As an indeterminate result, cell changes have occurred, but the cells are very close to normal and likely to thaw without treatment. The doctor will likely order a repeat test in 6 months.

Younger people are more susceptible to low-grade squamous intraepithelial lesions (LSIL), which usually resolves without treatment.

Cervical erosion, which doctors sometimes refer to as ectropion, can also lead to an uncertain outcome. Cervical erosion means cells of the underlying glands are visible on the surface of the cervix. Erosion is common, especially in people who use birth control pills, adolescents, or those who are pregnant. There may also be slight bleeding after sexual intercourse. Most cases of erosion resolve without treatment.

What to Do After Abnormal Results?

If a healthcare professional finds abnormal cells in the cervix, they may recommend further testing.

An abnormal result means that the pathologist has detected changes in the person’s cervix. This result does not necessarily mean that the person has cervical cancer. In most cases, there is no cancer.

Abnormal changes in cervical cells are usually caused by HPV. Low-grade changes are insignificant, while high-grade changes are more serious. Most low-grade changes resolve without treatment.

Normally, it takes 3-7 years for “high-grade” or serious abnormalities to develop into cervical cancer. Cells that show more severe changes can eventually become cancerous unless a doctor removes them. Early intervention is vital to the treatment of cervical cancer. Doctors will need to do more testing to confirm abnormal Pap or HPV test results.

Rarely, test results may indicate the presence of cervical intraepithelial neoplasia (CIN). This term means that the scan finds precancerous cells, but it does not mean that the person has cervical cancer.

Results may show:

  • CIN 1 (mild cell changes): One-third of the skin thickness covering the cervix has abnormal cells.
  • CIN 2 (moderate cell changes): Abnormal cells are found in two-thirds of the skin thickness that covers the cervix.
  • CIN 3 (severe cell changes): Abnormal cells are found in the entire thickness of the skin that covers the cervix.

A doctor will need to confirm these results by requesting a biopsy.

Browsing Security and Results

While both standard cervical screening tests are generally reliable and effective, vague or abnormal results may reflect a problem with the exam rather than the presence of changed cells.

A person may have to repeat the test due to an “insufficient” sample, meaning their results are unsatisfactory.

Insufficient sample may be due to:

  • Too few cells in the test
  • Presence of an infection that hides cells
  • Menstrual bleeding that makes it difficult to visualize cells
  • Inflammation of the cervix, which can block the visibility of cells

A person wishing to screen for cervical cancer should first take measures to clear infections or inflammation of the cervix.

Important Information About Screening Tests

Medically recommended tests for cervical cancer are the Pap test and the HPV test. These tests show changes in cells or the presence of the HPV virus, which may suggest a higher risk of cervical cancer.

Screening is usually quite effective and can allow for early treatment. However, results may be uncertain and further testing may be required.

Women over the age of 21 should have a Pap test every 3 years.

Source: Medicalnewstoday.com, What is cervical cancer screening?, 2020

References

  1. Overview of cervical cancer. (n.d.). http://www.nccc-online.org/hpvcervical-cancer/cervical-cancer-overview/
  2. Cervical cancer screening. (2016). http://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening
  3. Cervical Cancer Screening (PDQ) – Health Professional Edition. (2019). https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq#_1
  4. Cervical cancer statistics. (2018). https://www.cdc.gov/cancer/cervical/statistics/
  5. Diethylstilbestrol (DES) and cancer. (2011). https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/des-fact-sheet
  6. National Breast and Cervical Cancer Early Detection Program (NBCCEDP). (2019). https://www.cdc.gov/cancer/nbccedp/
  7. Pap tests. (2017). https://www.cdc.gov/nchs/fastats/pap-tests.htm
  8. Cervical cancer screening: US Preventive Task Force recommendation statement. (2018). https://jamanetwork.com/journals/jama/fullarticle/2697704
  9. American Cancer Society guidelines for the prevention and early detection of cervical cancer. (2018). https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html
  10. What do my cervical cancer screening test results mean? (2018). https://www.cdc.gov/cancer/cervical/basic_info/test-results.htm
  11. What should I know about scanning? (2017). https://www.cdc.gov/cancer/cervical/basic_info/test-results.htm

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