Cervical screening allows for the detection and treatment of cervical cancer in its early stages. To detect changes in the cells of the cervix and identify associated viruses, doctors utilise two major tests.
Cervical cancer occurs in the tiny area where the uterus meets the top of the vaginal canal at the lower end of the uterus. Human papillomavirus (HPV) is found in roughly 99 percent of cervical cancers, while most HPV instances do not progress to cancer. The most important risk factor for cervical cancer is having HPV.
Cervical cancer screening consists mostly on the Pap test and the HPV test.
Regular screening, according to the National Cancer Institute, lowers the risk of getting or dying from cervical cancer by 80% Trusted Source.
Because of advancements in testing and treatment, the incidence of deaths from cervical cancer in the United States is decreasing by about 2% per year.
We’ll look at how a pap test works, who should get one, and how to interpret the findings in this post.
Screening tests
Cervical cancer screening may include HPV testing or the Pap test. At the same time, the doctor may perform a physical examination of the pelvis.
Pap smear
A healthcare expert expands the vagina using a tool they call a speculum to gain access to the cervix. They next extract a sample of cells from the cervix. They will send the cell sample to a laboratory for evaluation under a microscope.
The laboratory technicians check at the appearance of the cells. If they appear abnormal, it may be a sign that cervical cancer is in the early stages of development, known as precancer.
Early treatment can rectify these cellular alterations and prevent the emergence of cervical cancer.
HPV test
A doctor will perform the HPV test to discover the virus underlying many aberrant cellular changes that could lead to cervical cancer.
However, the HPV DNA test may identifiy numerous infections that specialists do not relate to cancer. A positive HPV test often does not guarantee that a person will go on to get cancer.
Screening criteria and recommendations
The American Cancer Society provide advice for regular cervical cancer tests in females of all ages.
21–29 years
Between these ages, a woman should receive Pap tests at 3-year intervals. HPV testing is not necessary at this point. However, a doctor may follow up a Pap test with HPV testing if results are abnormal.
In one study, 86.7 percent of people who tested positive for HPV did not acquire cancer in at least the following 10 years.
30–65 years
Doctors prescribe the following for people of these ages:
- co-testing, or a combination of both tests, every 5 years
- a Pap test every 3 years
The American Cancer Society warn that a combined HPV and Pap test can lead to more false positives, additional testing, and more intrusive treatments.
Over 65 years
Women who have had regular screening in the last 10 years with clean findings throughout can stop screening at this age.
However, if a test within the last 20 years has showed indicators of a dangerous precancer, screening should continue until 20 years following this precancer finding.
Women with a high risk of cervical cancer
Those who have a greater risk of cervical cancer should have more frequent testing.
This includes females with a compromised immune system, such as those with HIV or a recent organ transplant. People might also have a high risk if they received exposure to diethylstilbestrol (DES), a synthetic type of oestrogen, before birth.
After a total hysterectomy, which involves removal of the uterus and cervix, screening is no longer necessary. However, if a doctor did the hysterectomy to treat cancer, screening should continue.
Females who have gotten an HPV vaccination should continue get tests.
A person who has current or past cervical cancer or precancer will have their own screening and treatment regimen, as well as individuals with HIV infection.
A false positive result may not only cause stress but might lead to unneeded procedures that may have long-term risks. For this reason, doctors do not advocate yearly screenings.
Interpreting results
Cervical screening test results can be normal, ambiguous, or abnormal.
Normal: There were no alterations in the cells of the cervix.
Unclear: The cells appear like they could be abnormal, and the pathologist could not discover alterations that could suggest precancer. These aberrant cells could relate to HPV, an infection, pregnancy, or life changes.
Abnormal: The lab technicians identified alterations in the cervical cells. Abnormal cells do not usually signify cancer. The doctor will typically request more tests and treatment to evaluate if the alterations are turning malignant.
In an uncertain outcome, cell alterations have occurred, but the cells are very near normal and are likely to resolve without treatment. The doctor will likely order a repeat test within 6 months.
Younger people are more susceptible to low-grade squamous intraepithelial lesions (LSIL) that commonly heal without therapy.
Cervical erosion, which doctors sometimes refer to as an ectropion, may potentially lead to an uncertain result. Cervical erosion means that the cells of underlying glands can be visible on the surface of the cervix.
Erosions are widespread, especially among those individuals who are using the contraceptive pill, teenagers, or someone who is pregnant. Slight bleeding could also occur after sex.
Most occurrences of erosions resolve without therapy.
What to do following abnormal results
An abnormal result signifies that the pathologist discovered alterations in the person’s cervix. This result does not necessarily suggest that the individual has cervical cancer. In most cases, there is no cancer.
The aberrant alterations in the cervical cells are commonly attributable to HPV. Low-grade changes are mild whereas high-grade changes are more significant. Most low-grade alterations resolve without treatment.
It generally takes 3–7 years for “high-grade,” or severe, abnormalities to become cervical cancer.
Cells showing more serious alterations may potentially turn malignant unless a specialist eliminates them. Early intervention is crucial for treating cervical cancer.
Doctors will need to undertake more testing to confirm abnormal Pap or HPV test results.
Rarely, test results could reveal the presence of cervical intraepithelial neoplasia (CIN) (CIN). This word signifies that the screening discovered precancerous cells, but not that the individual has cervical cancer.
The findings may show the following:
- CIN 1 (mild cell changes): One-third of the thickness of the skin that covers the cervix has abnormal cells.
- CIN 2 (moderate cell changes): Two-thirds of the thickness of the skin that covers the cervix has abnormal cells.
- CIN 3 (severe cell changes): All the thickness of the skin that covers the cervix has abnormal cells.
A doctor will need to confirm these results by requesting a biopsy.
Test difficulties
While both routine cervical screening tests are typically reliable and useful, confusing or abnormal results may represent a problem with the examination rather than the existence of altering cells.
A person may have to repeat the test due to a “inadequate” sample, implying that their results were inconclusive.
An insufficient sample could be due to:
- too few cells being available from the test
- the presence of an infection that obscures the cells
- menstruation, which can make viewing the cells hard
- inflammation of the cervix, which may obstruct the visibility of the cells
If you want to get a cervical cancer screening, you should first take care of any infections or irritation in your cervix.
Conclusion
The Pap test and the HPV test are medically recommended tests for cervical cancer. These tests reveal either cell alterations or the presence of the HPV virus, both of which indicate a higher risk of cervical cancer.
Screening is frequently quite effective, allowing for early treatment. However, the results may be ambiguous, necessitating further testing.
Every three years, females over the age of 21 should have a Pap test.
It is possible that screening will be pricey. Many insurance, on the other hand, cover testing. This site can be used by people who don’t have access to cervical cancer screening to see if they qualify for free testing under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
References
- http://www.nccc-online.org/hpvcervical-cancer/cervical-cancer-overview/
- http://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening
- https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq#_1
- https://www.cdc.gov/cancer/cervical/statistics/
- https://www.medicalnewstoday.com/articles/254577
- https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/des-fact-sheet
- https://www.cdc.gov/cancer/nbccedp/
- https://www.cdc.gov/nchs/fastats/pap-tests.htm
- https://jamanetwork.com/journals/jama/fullarticle/2697704
- https://www.cdc.gov/cancer/cervical/basic_info/test-results.htm
- https://www.cdc.gov/cancer/cervical/basic_info/test-results.htm
