Abnormal Cervical Cancer Screening

HPV test results show whether you have a high-risk type of HPV infection.

Results are negative or positive:

• A negative HPV test means that HPV was not found in your test sample.
• A positive HPV test means that you have an HPV infection. This does not mean that you have cancer now, but it may be a sign that cancer could develop later. You may need follow-up testing (see below).

• ASC-US—This means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. ASC-US is the most common abnormal Pap test result. ASC-US stands for atypical squamous cells of undetermined significance. “Squamous” refers to the type of cells that make up the tissue that covers the cervix.
• LSIL—This means that the cervical cells show changes that are mildly abnormal. LSIL is usually caused by an HPV infection that often goes away on its own. LSIL stands for low-grade squamous intraepithelial lesion.
• HSIL—This suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be linked to precancer and cancer. HSIL stands for high-grade squamous intraepithelial lesion.
• ASC-H—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL. ASC-H stands for atypical squamous cells, cannot exclude HSIL.
• AGC—This means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer. Glandular cells are another type of cell that make up the tissue that covers the inner canal of the cervix. Glandular cells are also present inside the uterus. AGC stands for atypical glandular cells.

If you have a positive HPV test or an abnormal Pap test result, you may need further testing. The following tests may be done depending on your risk for cervical cancer. Testing is based on your age, initial  
screening test result, and any previous test results. Types of follow-up testing include:

• Reflex testing—If you had an HPV test, a Pap test may be done on the same cells used for the HPV test. If you had a Pap test, an HPV test may be done on the same cells used for the Pap test. This is called reflex testing.
• HPV typing—There is another kind of HPV test that looks specifically for HPV type 16 and HPV type 18. These two types cause the most cases of cervical cancer. This kind of HPV test is called HPV typing.
• Repeat testing—Repeat HPV testing or co-testing (having the HPV test and Pap test done at the same time) may be done. The timing of repeat testing depends on your initial test result, your age, and the results of previous tests.
• Colposcopy, biopsy, and endocervical sampling—Colposcopy is an exam of the cervix with a magnifying device. If an area of abnormal cells is seen, you may need a cervical biopsy. For a biopsy, a small sample of tissue is removed and sent to a lab for testing. The lab testing can determine how severe the cell changes are. Endocervical sampling may also be done. This sampling uses a small brush or other instrument to take a tissue sample from the cervical canal.
• Endometrial sampling—A sample of the endometrium (the lining of the uterus) is collected for study. Some women with an AGC result need to have this follow-up test. If your initial test results show you have a very high risk of developing cervical cancer, you may consider treatment without additional testing. If your obstetrician–gynecologist (ob-gyn) recommends this option, you should talk together about the risks and benefits.

Cervical intraepithelial neoplasia (CIN) is used to report cervical biopsy results.

CIN describes the actual changes in cervical cells. CIN is graded as 1, 2, or 3:

• CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.
• CIN 2 is used for moderate changes.
• CIN 3 is used for more severe changes.

Moderate and severe changes can progress to cancer. These changes are called high-grade changes.

In general, there are two ways to treat abnormal cervical cells:

1. Excisional treatment—Tissue is removed from the cervix and sent to a laboratory to be studied. Results can tell whether CIN actually is present and, if so, how severe it is.
2. Ablative treatment—Abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

In some cases, the HPV vaccine may be given to help with treatment for CIN 2 or CIN 3.

Excisional treatments include the following:

• Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix.
• Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed.

Ablative treatments include the following:

• Cryotherapy—An instrument is used to freeze abnormal cervical tissue, which then sloughs off.
• Laser therapy—A focused beam of light is used to destroy abnormal cervical tissue.

The HPV vaccine may help prevent abnormal cells from returning after the cells have been removed or destroyed. The  HPV vaccine may be given to help with treatment for CIN if the following applies to you:

• You are getting treatment for moderate or severe CIN (CIN 2 or CIN 3).
• You are age 27 to 45 and have not previously gotten the HPV vaccine.
• You have a healthy immune system.

Anyone age 9 to 26 should get the HPV vaccine as usually recommended regardless of whether you are getting treatment for CIN.

Read Human Papillomavirus (HPV): Infection and Vaccination to learn more.

Yes. An HPV test is recommended 6 months after treatment. Then, you should continue with cervical cancer screening as recommended by your ob-gyn. The recommended screening schedule depends on what type of abnormal cell changes you had.

Talk with your ob-gyn about the screening you need.