The Digene hc2 High Risk HPV Test has been around for some years and checks for thirteen high risk strains of HPV, including HPV 16 and 18. While this test can determine if a woman is infected with a high risk strain, it is not that effective at identifying which high risk HPV strain she has. The second high risk HPV test, Cervista HPV HR is similar to the Digene hc2 High Risk HPV Test in that it screens for high risk strains of HPV. The difference between these two tests is that the Cervista HPV HR screens for fourteen strains compared to the thirteen that the Digene hc2 High Risk HPV Test screens for. Both tests are approved by the Food and Drug Administration (FDA) to screen for high risk strains of HPV in women over the age of 30. This means that the test is not approved for women under 30, even if they have an abnormal Pap smear. Women under 30 who are given this HPV test have a good chance of getting a false positive reading (the test falsely says that she has HPV), which is why it is not approved for this age group.
The newest test, Cervista HPV 16/18, is a test that checks specifically for HPV 16 and 18, which are the strains responsible for most cases of cervical cancer. The drawback to this particular test is that it must be administered together with the Cervista HPV HR test. Similar to the high risk HPV tests, the Cervista HPV 16/18 can only be administered on women above the age of 30.
The HPV tests are helpful to physicians whose patients over 30 have had Pap smears with abnormal or precancerous cells. A woman who has precancerous cells and a positive HPV test is more likely to develop cervical cancer. The HPV test confirms that the woman has strains of HPV that could cause cancer. The doctors are more likely to recommend immediate follow-up or treatment for these women than women with precancerous cells and no evidence of a high risk strain of HPV.
Women under 30 must rely exclusively on Pap smears once every three years for detecting and keeping a watchful eye on changes in cervical cells. The HPV test is of no use for women in this age group, because even if they are infected with one or more types of HPV most will be able to rid themselves of infection relatively quickly. If young women with abnormal Pap smears were given the HPV test, they would be likely to receive unnecessary treatment which could harm their reproductive system.
- The Bottom Line
- What Does It Mean if a Pap Smear Is Abnormal?
- Does an Abnormal Pap Mean HPV?
- What Happens When You Have an Abnormal Pap Smear?
- What Is Cervical Dysplasia?
- Understanding Abnormal Cervical Cancer Screening Results
- Path to improved health
- Cervical Cancer Screening: Pap and HPV Tests
The Bottom Line
Cervical cancer screening is simple, low-cost, and saves lives. Women should start getting Pap smears at 3-year intervals at age 21, and women over 30 whose Pap smear showed abnormal cells or pre-cancers may want to also get one of the HPV tests.
Each year, over 50 million Pap tests are performed in the United States to screen for cervical cancer. During this simple test, a small sample of cells are scraped from the cervix and examined under a microscope to look for precancerous changes. The Pap test is done to detect cancerous or precancerous cells early, when treatment is the most effective.
About 5% of all Pap tests will be abnormal, meaning that the sample contains atypical cervical cells. However, the majority of these cells are not cancerous or even precancerous. An abnormal Pap test result does not mean cancer, but it does require follow-up to rule out the possibility of cancer.
What Does It Mean if a Pap Smear Is Abnormal?
Healthy cervical cells are thin and flat. If your Pap test is abnormal, this means that your sample contained abnormally shaped cervical cells. Most of the abnormal cells found during a Pap test are the result of a cervical or vaginal infection and are not cancerous. Abnormal Pap tests are very common. In fact, of the 3 million women with abnormal Pap tests each year, less than 1% (13,240 cases) will be diagnosed with cervical cancer.
Does an Abnormal Pap Mean HPV?
Human papilloma virus (HPV) causes the majority of cervical cancers. HPV is a common infection, and most sexually active individuals have been exposed to at least one of the more than 100 known strains of HPV. However, the Pap test is not designed to detect HPV.
At Roswell Park, we use HPV testing in addition to the Pap test to increase the chance of detecting or preventing cases of cervical cancer.
What Happens When You Have an Abnormal Pap Smear?
If you have both an abnormal Pap smear and positive HPV test results, your doctor will suggest one or more of the following tests to rule out the possibility of cervical cancer or remove cancerous cells:
- Colposcopy. During this simple, minimally invasive procedure, the doctor takes a closer look at the cervix using a special instrument called a colposcope, which combines a bright light with a magnifying lens. If abnormal cells are found during a colposcopy, then a biopsy can be performed to determine whether these cells are cancerous or precancerous. A special stain is used during this procedure to increase the accuracy of the results.
- Biopsy. A small sample of tissue is removed from the cervix. A pathologist then checks this tissue under a microscope to rule out the possibility of cancer.
- Conization (cone biopsy or cold knife biopsy) and LEEP (loop electrosurgical excision procedure) are used to remove abnormal tissue from the cervix. These procedures are both diagnostic and therapeutic, ensuring that no cancerous cells are in the cervix while removing any precancerous cells that are found. LEEP is usually performed in your doctor’s office with local anesthesia, whereas cold knife conization is done in the hospital with general anesthesia.
If cancerous or precancerous cells are found, then treatment will depend on many factors, such as age and degree of abnormality.
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What Is Cervical Dysplasia?
One abnormality we often find upon further testing is called cervical dysplasia (otherwise known as cervical intraepithelial neoplasia), a precancerous condition in which abnormal cells begin growing on the cervical lining. Dysplasia can range in severity from low to high. High-grade dysplasia can turn into cervical cancer over time if not treated.
Fortunately, the progression from dysplasia to cervical cancer is usually quite slow (up to 10 years), and treatment can be highly effective during the early stages. There is a strong link between HPV infection and dysplasia, which is why we recommend routine HPV testing for women over 30.
Whether you come to Roswell Park for routine cervical cancer screening or a second opinion after an abnormal Pap test, we offer experience in cancer detection and treatment. If your Pap test or biopsy was taken at another location, our pathologists and cytopathologists can review your results. Remember that your doctor’s advice is only as good as the pathologist’s findings, so having an expert set of eyes on your test results will ensure that you get the right diagnosis.
To reduce your risk of developing cervical cancer, get screened regularly, practice safe sex, and talk to your doctor about the HPV vaccine, which protects against 9 different types of HPV strains that cause cancer or genital warts. Cigarette smoking increases your risk of developing cervical and other types of cancer, so avoiding tobacco products drastically reduces your overall cancer risk.
Understanding Abnormal Cervical Cancer Screening Results
Path to improved health
Your Pap test will come back with one of three results:
Normal (or negative). This means no cell changes were found.
Unclear (or inconclusive). This result is common. It means it looks like your cells could be abnormal. This could be because of an infection, such as a yeast infection or the herpes virus. Hormone changes from pregnancy or menopause can also affect test results.
Abnormal (or positive). This means cell changes were found. In most cases, it does not mean you have cervical cancer. There are different abnormal test results. These are the most common.
- ASC-US – Atypical squamous cells of undetermined significance
This is the most common abnormal finding. It is sometimes considered an unclear result rather than abnormal. Squamous cells form the surface of your cervix. This result means the squamous cells don’t look normal. This could be because of an infection, including HPV.
- AGC – Atypical glandular cells
Glandular cells produce mucus in your cervix and uterus. This result means some glandular cells don’t look normal. These cell changes are usually more serious than ASC (atypical squamous cells). This means there is a greater risk that precancer or cancer is present.
- LSIL – Low-grade squamous intraepithelial lesions
This result is sometimes called mild dysplasia. It indicates low-grade changes that are usually caused by an HPV infection. Changes may go away on their own.
- HSIL – High-grade squamous intraepithelial lesions
This result is also called moderate or severe dysplasia. It indicates that HPV is present and is causing more serious changes. These could turn into cancer if left untreated.
- ASC-H – Atypical squamous cells, cannot exclude HSIL
Some cells are not normal, and there is a possibility that HSIL is also present.
- AIS – Adenocarcinoma in situ
An advanced lesion was found in the glandular tissue. It could turn into cancer if left untreated.
- Cervical cancer cells (squamous cell carcinoma or adenocarcinoma)
Pap tests can detect cancer cells, but it is rare. Cancer usually does not have time to develop in women who get regular cancer screenings.
Most women with abnormal cervical cancer screening results do not have cancer.
If your screening found ASC-US, your doctor will probably order an HPV test. He or she may also have you come back in 6 to 12 months for another Pap test. If the HPV test is positive and you are older than 25, your doctor will order a colposcopy. During this test, he or she will use a magnifying lens to look more closely at your cervix. They can also take a sample of tissue (biopsy) to test for cancer.
Cells of the cervix go through many changes before they turn into cancer. A Pap test can show if your cells are going through these changes. If caught and treated early, cervical cancer is not life threatening. Talk to your doctor to see how often he or she recommends you receive Pap tests. You may need them or less often, depending on your age and overall health.
Cervical Cancer Screening: Pap and HPV Tests
Each year, more than 13,000 women are diagnosed with cervical cancer in the United States. Yet cervical cancer is one of the most preventable cancers today. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops.
We now know that these cell changes are caused by human papillomavirus, commonly known as HPV. The traditional test for early detection has been the Pap test. For women age 30 and over, an HPV test is also recommended. HPV tests can find any of the high-risk types of HPV that are commonly found in cervical cancer.
Current guidelines for cervical cancer screening are:
- Women should start screening with the Pap test at age 21. (Screening is not recommended for women under age 21.)
Starting at age 30, women have three options available for screening:
- 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 women may be screened more often.
After age 65, women older than 65 who have had adequate prior screening and are not otherwise at high risk can stop screening. Women 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.
The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. When a female has a Pap test, she is positioned on an exam table and a device called a speculum (pictured to the right) is gently inserted to open the vagina. The speculum allows the healthcare provider to view the cervix and upper vagina. Once the provider can see the cervix, a “broom” device or a brush/spatula combination will be used to collect the cells. While the technique is a little different depending on the device chosen, in general, the provider will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect squamous and glandular cells. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.
The Pap test looks for any 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)
- “Warts” on the cervix
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 woman has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often – and possibly do treatment – to prevent further cell changes that could become cancerous over time if left unchecked.
Download our fact sheet that simplifies cervical cancer screening guidelines.
HPV tests can find any of the high-risk types of HPV that are most commonly found in cervical cancer. The presence of any of these HPV types in a woman for many years can lead to cell changes that may need to be treated so that cervical cancer does not occur. The HPV test is done at the same time as the Pap test by using a small soft brush to collect cervical cells that are sent to the laboratory, or the HPV testing sample may be taken directly from the Pap sample.
A word about genotyping: two “high risk” HPV types (also called “genotypes), HPV 16 and HPV 18, are responsible for about 70% of cervical cancers worldwide. Knowing if a woman has these types of HPV gives healthcare providers more insight into her risk for developing cervical cancer.
As of 2018, an HPV test is now an option for primary cervical cancer screening (meaning it can be done alone without a Pap test). The test is followed by a Pap test for women with certain results. Don’t worry about which option is the best one for you: the exact test or tests used is not as important as simply being screened regularly! Your healthcare provider will help you sort out which option is right for you.
Preparing for a Pap and/or HPV Test
There are steps you can take to ensure you get the best possible results from your 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
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:
Descriptive System: Mild dysplasia, Moderate dysplasia, Severe dysplasia
CIN System CIN stands for cervical intraepithelial neoplasia. Results are classified as CIN 1, CIN 2, CIN 3
- 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) and High-Grade SIL (HSIL): SIL stands for squamous intraepithelial lesion. LSILs are considered mild abnormalities usually caused by an HPV infection. HSILs are considered more severe abnormalities and have a greater chance of progressing to invasive cancer.
Women 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.
What if Pap test results are abnormal?
If a Pap test shows abnormal cells, additional tests may be performed. These tests include:
Colposcopy: A colposcopy is an examination of the vagina and cervix using a lighted magnifying instrument called a colposcope.
Cervical biopsy: In a biopsy, the healthcare provider removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells. Most women have the biopsy in the doctor’s office, and no anesthesia is needed. To do the biopsy, the doctor will insert a speculum to hold the vagina open and take a very small sample. After the sample is taken, it will be sent to a laboratory where another doctor checks the tissue using a microscope. You may experience some bleeding and discharge after the exam and discomfort similar to menstrual cramps. Ibuprofen can be taken to relieve these symptoms.
Colposcopic biopsy: While viewing your cervix with a colposcope, the healthcare provider removes a tiny portion of abnormal tissue from the surface of the cervix with a special tweezers. The cells are then examined under a microscope.
Endocervical curettage: A procedure in which the mucous membrane of the cervical canal is scraped using a spoon-shaped instrument called a curette. This can be done in your healthcare provider’s office and does not require anesthesia. There may be some cramping and bleeding after the procedure.
Cone biopsy: A cone-shaped sample of tissue is removed from the cervix to see if abnormal cells are in the tissue beneath the surface of the cervix. This specimen is much bigger than the biopsy done in the office without anesthesia. A sample of tissue can be removed for a cone biopsy using a LEEP cone procedure, which can be done under local anesthesia, or a knife cone procedure, done in an operating room under local or general anesthesia. You may have some vaginal bleeding for about a week and some spotting for about three weeks after the procedure.
LEEP (Loop Electro-Surgical Excision Procedure): The LEEP is performed using a small heated wire to remove tissue and precancerous cells from the cervix. This procedure can be done in your provider’s office and requires local anesthesia. There may be some cramping during and after the procedure. You may have moderate to heavy vaginal discharge that lasts for up to three weeks.