HPV and Cervical Cancer
The majority of people with a cervix who experience an HPV infection will not develop cervical cancer, but regular screening is very important. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes.
These changes are typically detected through a Pap test. A Pap test checks for abnormal or precancerous changes in the cells on the cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:
- Abnormal cell changes
- Precancerous cells changes
- CIN (cervical intraepithelial neoplasia)
- SIL (squamous intraepithelial lesions)
All of these terms mean similar things—it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV.
There are many types of HPV that can cause cervical dysplasia. Most of these types are considered “high-risk” types, which means that they have been linked with cervical cancer. Just because a person has cervical dysplasia, it does not mean they will get cervical cancer. It means that their healthcare provider will want to closely monitor their cervix every so often—and possibly do treatment—to prevent further cell changes that could become cancerous over time if left unchecked.
Cervical cancer is a slow-growing condition that usually takes years to progress. This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress.
When and how do I screen for cervical cancer?
Screening begins with a Pap test at age 21 (screening is not recommended before 21), done every three years. At age 30, there are three different options:
- A Pap test alone every three years
- Co-testing with a Pap and HPV test, every five years
- An HPV test alone, every five years
Depending on the results of the Pap and/or HPV tests, a healthcare provider may recommend additional screening or procedures, so some people may be screened more often.
After age 65, people older than 65 who have had adequate prior screening and are not otherwise at high risk can stop screening. Cisgender women or transmasculine people who have had a hysterectomy (with removal of the cervix) also do not need to be screened, unless they have a have a history of a high-grade precancerous lesions.
How do I prepare for a Pap or HPV test?
- Try to schedule the test on a day when you do not expect to be on your menstrual period. If your period begins unexpectedly and will be continuing on the day of your test, try to reschedule the appointment.
- Avoid sexual intercourse 48 hours before the test.
- Do not douche 48 hours before the test.
- Do not use tampons, or vaginal creams, foams, films, or jellies (such as spermicides or medications inserted into the vagina) for 48 hours before the test
What about abnormal test results?
The term “abnormal Pap” is broad and not very specific. There are many different systems that healthcare providers use to classify a Pap test. Within each system, there are different degrees of severity or abnormalities. The various classification systems and degrees of severity include:
Degrees of Severity:
- Mild dysplasia
- Moderate dysplasia
- Severe dysplasia
Degrees of Severity:
- CIN 1
- CIN 2
- CIN 3
*CIN stands for cervical intraepithelial neoplasia
Bethesda System (2001)
Degrees of Severity:
- ASC-US (Atypical Squamous Cells of Undetermined Significance): Means the results look borderline between “normal” and “abnormal” – often not HPV-related
- ASC-H (Atypical Squamous Cells-can not exclude HSIL): Borderline results, but may really include High-Grade lesions
- Low-Grade SIL (LSIL): SIL stands for squamous intraepithelial lesion
- High-Grade SIL (HSIL)
People with abnormal Pap test results are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap test. If the Pap result is “ASC-US,” then a HPV-DNA test may be done in the lab to see whether HPV is causing this borderline “normal-abnormal” Pap result.
Are the Pap test, HPV test, and biopsy the same?
A Pap test, or Pap smear, is a screening to find abnormal cell changes on the cervix (cervical dysplasia) before they ever have a chance to turn into cancer. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then usually put in a container with liquid, and sent to the laboratory for evaluation.
A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap test result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.
An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the “high-risk” types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test.
How is cervical dysplasia treated?
Currently, there is no treatment to cure HPV. However, there are several treatment options available for treating the abnormal cells. Sometimes treatment may not even be necessary for mild cervical dysplasia. These cells can heal on their own and the healthcare provider will just want to monitor the cervix. HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable.
The goal of any treatment will be to remove the abnormal cells. This may also end up removing most of the cells with the HPV in them. If the abnormal cells are treated, or if they have healed on their own, it may possibly help reduce the risk of transmission to a partner who may have never been exposed to the cell-changing types of HPV.
When choosing what treatment to use, the healthcare provider will consider many things:
- location of the abnormal cells
- size of the lesions on the cervix
- degree or severity of the Pap test results
- degree or severity of the colposcopy and biopsy results
- HPV test results (if this test was needed)
- age and pregnancy status
- previous treatment history
- patient and healthcare provider preferences
There are a variety of treatments for cervical dysplasia:
- Cryotherapy (freezing the cells with liquid nitrogen)
- LEEP (Loop Electrosurgical Exision Procedure)
- Conization (also called cone biopsy)
- Laser (not as widely used today due to high cost, lack of availability, and not all doctors are well-trained with using it. LEEP is more commonly used)
- No treatment at all since even mild abnormal cell changes may resolve without treatment. The healthcare provider may just monitor the cervix by either doing a colposcopy, repeat Pap testing, or a test for HPV.
What about HPV and pregnancy?
If someone has an abnormal Pap test during pregnancy, even if it’s severely abnormal, many healthcare providers will not do treatment, primarily due to the concern that it may accidentally cause early labor. They will just monitor the cervix closely with a colposcope during the pregnancy.
Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap test or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved, and no treatment will be necessary. The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.