What is HPV and how does it relate to cancer. How is HPV transmitted and what are its symptoms. Can HPV vaccination prevent cancer. What types of cancers are caused by HPV infection.

What is HPV and How Does It Affect Human Health?

Human papillomavirus (HPV) is a group of over 200 related viruses that can significantly impact human health. These viruses are categorized into two main groups: low-risk and high-risk HPVs.

• Low-risk HPVs: Generally harmless, but some can cause genital warts
• High-risk HPVs: Can lead to various types of cancer

Among the high-risk HPVs, there are approximately 14 types, with HPV16 and HPV18 being the most notorious for causing cancer. HPV infection is remarkably common, affecting nearly all sexually active individuals within a few years of becoming sexually active.

How Prevalent is HPV Infection?

HPV infection is extremely widespread. Around half of all HPV infections involve a high-risk type. Both males and females can contract HPV and develop HPV-related cancers. However, it’s crucial to understand that most HPV infections do not lead to cancer. The immune system typically controls these infections, preventing them from causing severe health issues.

The Connection Between HPV and Cancer Development

While most HPV infections don’t result in cancer, persistent high-risk HPV infections can lead to cellular changes that may progress to cancer if left untreated. This process usually occurs over many years, highlighting the importance of regular screenings and early intervention.

What Factors Influence HPV-Related Cancer Development?

Several factors can influence whether an HPV infection leads to cancer:

• The specific type of HPV (high-risk vs. low-risk)
• The duration of the infection
• The strength of the individual’s immune system
• Presence of other risk factors (e.g., smoking, HIV infection)

Types of Cancers Caused by HPV Infection

HPV can cause cancer in various parts of the body where it infects cells. These areas include the cervix, oropharynx, anus, penis, vagina, and vulva. The majority of HPV-related cancers are squamous cell carcinomas, as HPV infects the squamous cells lining these organs.

What is the Global Impact of HPV-Related Cancers?

The burden of HPV-related cancers is significant worldwide:

• In the United States: HPV causes 3% of all cancers in women and 2% in men
• Globally: High-risk HPVs are responsible for about 5% of all cancers
• Annual cases: Approximately 570,000 women and 60,000 men develop HPV-related cancers each year

Cervical cancer, in particular, is a major concern in low- and middle-income countries, where screening and early treatment options are limited.

Transmission and Symptoms of HPV Infection

HPV is primarily transmitted through intimate skin-to-skin contact, including various forms of sexual activity. This includes vaginal-penile sex, penile-anal sex, oral sex, and even the use of sex toys or other objects.

Can Protective Measures Prevent HPV Transmission?

While condoms and dental dams can reduce the risk of HPV transmission, they do not provide complete protection. The virus can infect areas not covered by these barriers, making it challenging to prevent transmission entirely.

Do HPV Infections Always Cause Noticeable Symptoms?

High-risk HPV infections often do not cause immediate symptoms. This lack of obvious signs makes regular screening crucial, especially for cervical cancer. However, if HPV-related precancerous lesions or cancer develop, they may cause symptoms such as:

• Itching or bleeding in affected areas
• Pain or discomfort
• Swollen glands
• Unusual discharge

It’s important to note that these symptoms can also be caused by other conditions, so proper medical evaluation is essential for accurate diagnosis.

HPV Vaccination: A Powerful Tool for Cancer Prevention

HPV vaccination is a groundbreaking approach to preventing HPV-related cancers and diseases. The current HPV vaccine, Gardasil 9®, offers protection against nine HPV types, including seven high-risk types responsible for most HPV-related cancers.

How Effective is HPV Vaccination in Preventing Cancer?

HPV vaccination is highly effective in preventing new HPV infections and, consequently, HPV-associated cancers. When administered at the recommended ages of 9-12, the vaccine can prevent up to 90% of HPV-related cancers. This remarkable efficacy makes HPV vaccination a crucial tool in public health efforts to reduce cancer incidence.

Who Should Receive the HPV Vaccine?

The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for the following groups:

• All children aged 11-12 years (can start as early as age 9)
• Teens and young adults up to age 26 who haven’t been vaccinated
• Some adults aged 27-45 years, after discussing with their healthcare provider

It’s important to note that the vaccine is most effective when given before potential exposure to HPV through sexual activity.

The Importance of Regular Screening for HPV-Related Cancers

While HPV vaccination is a powerful preventive measure, regular screening remains crucial for early detection and treatment of HPV-related cancers, especially cervical cancer.

What Screening Methods are Available for Cervical Cancer?

There are several screening methods available for cervical cancer detection:

• Pap smear: Examines cervical cells for abnormalities
• HPV test: Detects the presence of high-risk HPV types
• Co-testing: Combines Pap smear and HPV test for more comprehensive screening

The frequency of screening depends on age and individual risk factors. It’s essential to follow healthcare provider recommendations for screening schedules.

Living with HPV: Managing Infection and Reducing Cancer Risk

For individuals diagnosed with HPV, there are several steps to manage the infection and reduce cancer risk:

1. Follow up with regular screenings as recommended by healthcare providers
2. Attend all follow-up appointments for any abnormal test results
3. Maintain a healthy lifestyle to support immune function
4. Quit smoking, as it can increase the risk of HPV-related cancers
5. Use barrier methods during sexual activity to reduce the risk of transmitting HPV to partners
6. Consider HPV vaccination if not already vaccinated (even if already infected, as it may protect against other HPV types)

Can HPV Infections Be Cured?

While there is no cure for HPV itself, most infections clear on their own within two years. However, persistent infections with high-risk types require close monitoring and may need treatment if precancerous changes occur.

Future Directions in HPV Research and Prevention

Ongoing research in HPV and related cancers focuses on several key areas:

• Developing more effective screening methods
• Improving treatment options for HPV-related precancerous lesions and cancers
• Enhancing vaccine efficacy and expanding coverage
• Understanding the long-term impact of widespread HPV vaccination
• Developing therapeutic vaccines for those already infected with HPV

How Might Future Advancements Impact HPV-Related Cancer Rates?

As research progresses, we can expect to see:

• Reduced incidence of HPV-related cancers due to increased vaccination rates
• More personalized screening and treatment approaches
• Improved global access to HPV prevention and treatment strategies
• Potential development of new therapies targeting HPV-infected cells

These advancements hold promise for significantly reducing the burden of HPV-related cancers worldwide.

The Role of Public Health Education in HPV Prevention

Public health education plays a crucial role in preventing HPV-related cancers. Increasing awareness about HPV, its connection to cancer, and the importance of vaccination and screening can significantly impact public health outcomes.

What Strategies Can Improve HPV Awareness and Prevention?

Effective strategies for improving HPV awareness and prevention include:

• Comprehensive sex education programs in schools
• Public health campaigns targeting various age groups and demographics
• Healthcare provider education to improve patient communication about HPV
• Community outreach programs to address cultural barriers to HPV prevention
• Integration of HPV education into routine healthcare visits

By implementing these strategies, we can work towards reducing HPV transmission and related cancer incidence on a global scale.

HPV and Cancer – National Cancer Institute

What is HPV (human papillomavirus)?

HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex. Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

HPV infection is common: Nearly all sexually active people are infected with HPV within months to a few years of becoming sexually active. Around half of these infections are with a high-risk HPV type.

HPV can infect both males and females. Both men and women can become infected with HPV and develop HPV-caused cancers.

Most HPV infections don’t cause cancer: Your immune system usually controls HPV infections so they don’t cause cancer.

High-risk HPV infections that persist can cause cancer: Sometimes HPV infections are not successfully controlled by your immune system. When a high-risk HPV infection persists for many years, it can lead to cell changes that, if untreated, may get worse over time and become cancer.

HPV vaccination can prevent cancer: HPV vaccines can prevent infection with disease-causing HPV types, preventing many HPV-related cancers and cases of genital warts.

What Cancers Are Caused by HPV Infection?

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (the part of the throat at the back of the mouth, behind the oral cavity that also includes the back third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils), anus, penis, vagina, and vulva.  

HPV infects the squamous cells that line the inner surfaces of these organs. For this reason, most HPV-related cancers are a type of cancer called squamous cell carcinoma. Some cervical cancers come from HPV infection of gland cells in the cervix and are called adenocarcinomas.

HPV-related cancers include:

In the United States, high-risk HPVs cause 3% of all cancers in women and 2% of all cancers in men. Each year, there are about 45,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 36,000 of these, according to the Centers for Disease Control (CDC).

Worldwide, the burden of HPV-related cancers is much greater. High-risk HPVs cause about 5% of all cancers worldwide, with an estimated 570,000 women and 60,000 men getting an HPV-related cancer each year. Cervical cancer is among the most common cancers and a leading cause of cancer-related deaths in low- and middle-income countries, where screening tests and treatment of early cervical cell changes are not readily available.

How is HPV Transmitted?

HPV passes easily between sexual partners. It can be transmitted through any intimate skin-to-skin contact, including vaginal–penile sex, penile–anal sex, penile–oral sex, vaginal–oral sex, and use of sex toys or other objects. The infection passes easily between sexual partners. Condoms and dental dams can lower the chance of HPV transmission but do not prevent it completely.

Does HPV Infection Cause Symptoms?

Infection with high-risk HPV does not usually cause symptoms. The precancerous cell changes caused by a persistent HPV infection at the cervix rarely cause symptoms, which is why regular cervical cancer screening is important. Precancerous lesions at other sites in the body may cause symptoms like itching or bleeding. And if an HPV infection develops into cancer, the cancer may cause symptoms like bleeding, pain, or swollen glands. Learn more about signs and symptoms of cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers.

HPV Vaccination: Preventing HPV Infection

The HPV vaccine Gardasil 9® protects against infection from nine HPV types: the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPV types that cause most HPV-related cancers.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated cancers and other diseases.

HPV vaccination provides strong protection against new HPV infections. Vaccination is prevention and does not cure an infection once you have it. The HPV vaccine is not used to treat HPV infections or diseases caused by HPV. HPV vaccination offers the most protection when given at ages 9-12. HPV vaccination is estimated to prevent up to 90% of HPV-related cancers.

Who should get the HPV vaccine?

The HPV vaccine series is recommended for girls and boys, at the age of 11 or 12, and the series can be started at age 9. It is important for males as well as females to get vaccinated, because both men and women can develop cancers of the mouth and throat, anal cancers, and genital warts. Women are also at risk for cervical cancer, and men for penile cancer. Vaccination can also reduce the spread of HPV that causes cancer to other people. 

Children who start the vaccine series before age 15 need two doses to be protected. For young people who weren’t vaccinated within the age recommendations, HPV vaccination is recommended up to age 26. Those who receive their first dose at age 15 or older need three doses to be protected.

Can the HPV vaccine be given at older ages?

Yes, the vaccine can be given to adults between the ages of 27 and 45 who didn’t receive all vaccine doses earlier. Adults in this age group benefit less from the vaccine because they are more likely to have been exposed to HPV already. Therefore vaccination is not routinely recommended for people in this age group. If you are concerned that you are at risk for a new HPV infection, talk with your health care provider about whether HPV vaccination may be right for you.

Learn more about the human papillomavirus (HPV) vaccine.

Screening for HPV and Cell Changes Caused by HPV

Screening tests are used to check for disease when there are no symptoms. The goal of screening for cervical cancer is to find precancerous cell changes at an early stage, before they become cancer and when treatment can prevent cancer from developing.

Currently, cervical cancer is the only HPV-caused cancer for which FDA-approved screening tests are available. Screening for cervical cancer is an important part of routine health care for people who have a cervix. This includes women and transgender men who still have a cervix. Cervical cancer screening tests include the HPV test that checks cervical cells for high-risk HPV, the Pap test that checks for cervical cell changes that can be caused by high-risk HPV, and the HPV/Pap cotest that checks for both high-risk HPV and cervical cell changes. 

Learn more about HPV and Pap testing and find out about next steps after an abnormal Pap test or positive HPV test.  

Sometimes an HPV infection can become active again after many years. Learn more about what it means if a woman has a positive HPV test after many years of negative tests.

Screening for Other HPV-Related Cancers

There are no Food and Drug Administration (FDA) approved tests to detect HPV infections or HPV-caused cell changes in anal, vulvar, vaginal, penile, or oropharyngeal tissues. Research studies are ongoing to identify tests that can detect precancers in these areas or find cancer in an earlier, more treatable stage. 

Anal cancer screening: Among populations that are at higher risk for HPV infection, such as men who have sex with men or men who are HIV positive, some research has found that an anal Pap test (also called an anal Pap smear) may help to detect early cell changes or precancerous cells. Research is ongoing to see if treating anal precancer prevents anal cancer.

Learn more about Anal Cancer Prevention (PDQ®).

Oral cancer screening: Currently, there are no standard screening tests for oral cancer. The United States Preventive Services Task Force (USPSTF) has found that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults. However, the American Dental Association (ADA) recommends dentists check for signs of oral and oropharyngeal cancer as part of a routine dental check-up in all patients.

Learn more about Oral Cavity, Pharyngeal, and Laryngeal Cancer Screening (PDQ®) and about symptoms in Oropharyngeal Cancer Treatment (Adult) (PDQ®).

Treatment for Cell Changes Caused by HPV Infection

Although HPV infection itself cannot be treated, there are treatments for the precancerous cell changes caused by infection with high-risk HPV.

Precancerous cervical cell changes: Most women who have precancerous cervical cell changes are treated with the loop electrosurgical excision procedure (LEEP), which is a method to remove the abnormal tissue.

Learn more about treatments for abnormal cervical cell changes.

Precancerous vaginal, vulvar, penile, and anal lesions and genital warts: Treatment methods include topical medicines, surgical excision, cryosurgery, and laser therapy.

HPV-related cancers: Individuals who develop an HPV-related cancer generally receive the same treatment as patients with tumors at the same site that are not related to HPV infection. However, patients with HPV-positive oropharyngeal cancer may receive different treatments than patients whose oropharyngeal cancers are not caused by HPV.

Learn more about treatment options for oropharyngeal cancer, including targeted therapy and new types of treatment such as immunotherapy being tested in clinical trials.

How Does HPV Cause Cancer?

HPV infection causes cells to undergo changes. If not treated these cells can, over time, become cancer cells.

Credit: National Cancer Institute

Once high-risk HPV infects cells, it interferes with the ways in which these cells communicate with one another, causing infected cells to multiply in an uncontrolled manner. These infected cells are usually recognized and controlled by the immune system. However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can become cancer. Research has found that it can take 10 to 20 years, or even longer, for HPV-infected cervical cells to develop into a cancerous tumor.

Among women whose cervical cells are infected with high-risk HPV, several factors increase the chance that the infection will be long lasting and lead to precancerous cervical cells. These include:

• Having a very aggressive HPV type, particularly HPV 16 or HPV 18. If you have either of these HPV types, make sure you receive diagnostic testing with a colposcopy. 
• Smoking cigarettes. Quitting smoking can help your body to fight HPV. 
• Having a weakened immune system. If you have HIV or are taking medicines that suppress your immune system, talk to your health care provider about diagnostic testing and follow-up.

NCI and HPV-Related Research

Clinical trials are an important step in learning about better ways to prevent, diagnose, and treat diseases, such as cancers caused by HPV. NCI’s Cancer Information Service can help you learn about HPV-related trials in the United States.

The National Cancer Institute is conducting and funding research to learn more about HPV:

• The Division of Cancer Epidemiology and Genetics (DCEG) conducts research into cervical and other HPV-related cancers to advance our understanding of how HPV causes cancer, evaluates screening practices to determine the most effective methods to detect precancerous changes early, develops and tests new approaches to screening that may be easier to use in low-resource settings, and refines tools for risk assessment in the clinic to help health care providers follow up on abnormal screening test results. Investigators in DCEG conducted the first population-based clinical trial of HPV vaccines.
• The Division of Cancer Prevention (DCP) conducts and fosters the development of research on the prevention and early detection of human papillomavirus (HPV)-related cancers and related conditions.
• The Division of Cancer Control and Population Sciences (DCCPS) supports research-tested intervention programs related to HPV and the investigation of implementation strategies to promote the HPV vaccine in regions with low HPV vaccine rates.
• The Center for Cancer Research (CCR) is home to scientists and clinicians who are exploring the cutting-edge of cancer-related research. CCR scientists work on a wide spectrum of biological and biomedical problems, including HPV. Investigators in CCR conducted the research that led to the initial development and characterization of the human papillomavirus (HPV) vaccines.

New ACS Cervical Cancer Screening Guideline

September 18, 2020,
by NCI Staff

Widely used guidelines on screening women for cervical cancer have several important changes, including a recommendation to start screening at a slightly older age and use of an HPV test as the primary screening test.

Credit: iStock

Routine cervical cancer screening is very effective for preventing cervical cancer and deaths from the disease. On July 30, the American Cancer Society (ACS) published an updated guideline for cervical cancer screening. The guideline’s recommendations differ in a few ways from ACS’s prior recommendations and those of other groups. An expert on cervical cancer screening, Nicolas Wentzensen, M.D., Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, explains the changes.

How have the cervical cancer screening recommendations changed?

The American Cancer Society’s new guideline has two major differences from previous guidelines. One is to start screening at a slightly older age, and the other is to preferentially recommend a type of screening test called an HPV test.

ACS recommends cervical cancer screening with an HPV test alone every 5 years for everyone with a cervix from age 25 until age 65. If HPV testing alone is not available, people can get screened with an HPV/Pap cotest every 5 years or a Pap test every 3 years.

These recommendations differ slightly from those given by ACS in 2012 and by the US Preventive Services Task Force (USPSTF) in 2018.

What’s the difference between an HPV test, a Pap test, and an HPV/Pap cotest?

A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. For an HPV/Pap cotest, an HPV test and a Pap test are done together.

For a patient at the doctor’s office, an HPV test and a Pap test are done the same way—by collecting a sample of cervical cells with a scraper or brush.

The Pap test has been the mainstay of cervical cancer screening for decades. HPV tests are a newer method of cervical cancer screening. Two HPV tests have been approved by the Food and Drug Administration (FDA) for use as a primary HPV test, meaning it is not part of an HPV/Pap cotest. Other HPV tests are approved as part of an HPV/Pap cotest.

Why does the new guideline recommend an HPV test over a Pap test or HPV/Pap cotest? 

All three tests can find cervical cancer precursors before they become cancer. But studies have shown that HPV tests are more accurate and more reliable than Pap tests. Also, you can rule out disease really well with HPV tests so they don’t have to be repeated as frequently.

Although the Pap test has led to huge drops in rates of cervical cancer and death from the disease, it has some limitations. Pap tests have lower sensitivity compared with HPV tests, so they may miss some precancers and have to be repeated frequently. They also detect a range of abnormal cell changes, including some minor changes that are completely unrelated to HPV. So, many people who get an abnormal Pap test result actually have a very low chance of developing cervical cancer.

HPV/Pap cotesting is only slightly more sensitive than HPV testing, but it is less efficient because it requires two tests. And it detects a lot of minor changes that have a very low risk of turning into cancer. For an entire population, that’s a lot of additional effort and cost.

Screening with an HPV test alone was not recommended by ACS in 2012 because that approach wasn’t yet approved by FDA. The 2018 USPSTF guideline included HPV testing alone, cotesting, and Pap testing as equal options. The difference in the new ACS guidelines is that they elevate HPV testing alone over the other two tests.

Why does the new guideline recommend screening starting at age 25, instead of age 21?

Using information from new studies, ACS concluded that the benefits of cervical cancer screening do not outweigh the harms for people aged 21 to 24 years old.

This is an important change that is related to HPV vaccines. The first cohort of women who received the HPV vaccine when they were younger are now in their 20s and are eligible for cervical cancer screening. HPV vaccines are very good at preventing HPV infections, particularly infection with HPV types 16 and 18, the types that cause most cervical cancers. So, the vaccines have led to a drop in HPV infections and cervical precancer in this age group.

Also, in young women, most HPV infections go away on their own. Screening people in this age group often leads to unnecessary treatment, which can have side effects. That’s why ACS recommends starting screening at age 25.

Have the recommendations for those who are 65 years old or older changed?

No, the recommendations for this age group are the same as before. If you’ve had a series of normal screening test results over a long period of time, then you can stop screening at age 65. If, in the past, you had an abnormal result or anything suspicious on a screening test, or had treatment for cervical cancer or precancer, then you should continue to be screened. 

The recommended age limit for cervical cancer screening has been consistent across different guidelines over the years. But there are current efforts to study the age limit more because it’s an area where we have less data. There is more interest now in looking at people who had an abnormal screening test result at an older age to see if they require more years of screening or more frequent screening.

If these screening tests save lives, isn’t it better for people to get tested more often and with more tests?

No. As with many tests, there is the potential to do more harm than good if they are applied too frequently. There are a few risks that come with cervical cancer screening tests. 

Screening tests and follow-up tests can cause physical discomfort. There’s also the possibility of added anxiety and other emotions from incorrect, or false-positive, test results. And if you have an incorrect result, you may end up getting unnecessary follow-up tests or even unnecessary treatment.

Treatment for cervical cancer or precancer can permanently alter the cervix. That may raise the risk of serious complications in a future pregnancy, including pregnancy loss and preterm birth.

So, while testing more often or with more tests may seem like a good idea, it can actually lead to more harms. ACS carefully evaluated the potential benefits and harms of each screening test for each age group to come up with their updated recommendations.

Do people who got the HPV vaccine still need to get cervical cancer screening?

Yes, the new guideline recommends screening for those who have had the HPV vaccine. It does not recommend making a screening decision based on whether an individual has had the vaccine.

Nicolas Wentzensen, M.D., Ph.D.

Senior Investigator

NCI Division of Cancer Epidemiology & Genetics

Credit: National Cancer Institute

But, over time, as rates of HPV vaccination increase among people who are eligible for cervical cancer screening, we may see more changes in screening recommendations down the road.

Why do the guidelines for cervical cancer screening keep changing?

It’s a very dynamic situation, and that’s for multiple reasons. One is we have amazing results from the HPV vaccine, so that continually changes the picture for screening.

We also have seen great development of new technologies like HPV testing and improvement in some of the secondary tests that are used for following up after screening.

All these improvements have allowed us to make more accurate predictions of a person’s chances of getting cervical precancer and cancer. We also have new evidence from large studies that really give us the assurance that we can update screening practices to provide better outcomes for women and for the health care system.

What happens after someone gets an abnormal cervical screening test result?

If something abnormal or suspicious was found, also called a positive test result, you will typically get a second test. The standard approach is to do a Pap test, but there is also a new FDA-approved test, called dual stain. The dual stain test uses two biomarkers that can give a more accurate sign that precancer is present.

The results of the second test will help decide if you need a colposcopy—a procedure to look at the cervix with a magnifying lens and take samples from spots on the cervix that look abnormal.

ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. Several NCI scientists, including myself, performed extensive risk assessment and systematic literature reviews to support the development of the guidelines.

Using all the information that we have on the risk of cervical cancer and precancer, the guidelines create a framework that helps doctors make decisions about follow-up care based on a patient’s total risk level.

The 2012 ASCCP guidelines were based on which test a patient got and what the results were. The new recommendations are more precise and tailored to many factors that determine a person’s risk of cervical cancer and precancer, such as their age and past test results.

Now, doctors can use any combination of test results to determine an individual’s risk and decide whether that person should, for example, get a colposcopy or come back in a year to repeat the screening test.

What Do My Cervical Cancer Screening Test Results Mean?

A Pap test result can be normal, unclear, or abnormal. An HPV test result can be positive or negative.

Two screening tests can help prevent cervical cancer or find it early—

• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
• The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.

The Pap test is recommended for all women between the ages of 21 and 65 years old. If you are 30 years old or older, you may choose to get a Pap test only, an HPV test only, or both tests together.

Pap Test Result

A Pap test result can be normal, unclear, or abnormal.

Normal

A normal (or “negative”) result means that no cell changes were found on your cervix. This is good news. But you still need to get Pap tests in the future. New cell changes can still form on your cervix.

Your doctor may tell you that you can wait three years for your next screening test if you received a Pap test only. If you also received an HPV test, and the result is negative, your doctor may tell you that you can wait five years for your next screening test.

Unclear (ASC-US)

It is common for test results to come back unclear. Your doctor may use other words to describe this result, like equivocal, inconclusive, or ASC-US. These all mean the same thing—that your cervical cells look like they could be abnormal. It is not clear if it’s related to HPV. It could be related to life changes like pregnancy, menopause, or an infection. The HPV test can help find out if your cell changes are related to HPV. Ask your doctor what to do next.

Abnormal

An abnormal result means that cell changes were found on your cervix. This usually does not mean that you have cervical cancer. Abnormal changes on your cervix are likely caused by HPV. The changes may be minor (low-grade) or serious (high-grade). Most of the time, minor changes go back to normal on their own. But more serious changes can turn into cancer if they are not removed. The more serious changes are often called “precancer” because they are not yet cancer, but they can turn into cancer over time. In rare cases, an abnormal Pap test can show that you may have cancer. You will need other tests to be sure. The earlier you find cervical cancer, the easier it is to treat.

HPV Test Result

An HPV test result can be positive or negative.

Negative

A negative HPV test means you do not have an HPV type that is linked to cervical cancer. Your doctor may tell you that you can wait five years for your next screening test.

Positive

A positive HPV test means you do have an HPV type that may be linked to cervical cancer. This does not mean you have cervical cancer now. But it could be a warning. The specific HPV type may be identified to determine the next step.

Abnormal Cervical Cancer Screening Test Results

Anus: The opening of the digestive tract through which bowel movements leave the body.

Biopsy: A minor surgical procedure to remove a small piece of tissue. This tissue is examined under a microscope in a laboratory.

Cells: The smallest unit of a structure in the body. Cells are the building blocks for all parts of the body.

Cervical Biopsy: A minor surgical procedure to remove a small piece of cervical tissue. This tissue is examined under a microscope in a laboratory.

Cervical Intraepithelial Neoplasia (CIN): Abnormal changes in the cells of the cervix that are caused by infection with human papillomavirus (HPV). CIN is graded as 1 (low grade), 2 (moderate), or 3 (high grade).

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Colposcopy: Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope.

Conization: A procedure that removes a cone-shaped wedge of tissue from the cervix.

Cryotherapy: A freezing technique used to destroy diseased tissue.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth, and throat.

Loop Electrosurgical Excision Procedure (LEEP): A procedure that removes abnormal tissue from the cervix using a thin wire loop and electric energy.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer.

Penis: The male sex organ.

Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.

What Is It & Tests

Overview

What is a Pap smear?

A Pap smear (also called a Pap test) screens for cervical cancer. The test checks for abnormal cells in the cervix that are cancerous or have the potential to become cancerous. During a Pap smear, your healthcare provider takes cells from the cervix to examine under a microscope for signs of cancer. The test is named for an American physician, Dr. George Papanicolaou, who developed the Pap smear.

What is the cervix?

The cervix is the lower part of the uterus that connects to the vaginal canal. Sperm travels through the vaginal canal and cervix to the uterus to fertilize eggs. During pregnancy, the cervix closes to keep the baby in the womb (uterus). The cervix opens during childbirth. When you aren’t pregnant, your cervix makes mucus to keep infection-causing bacteria out of the body.

Why do healthcare providers perform Pap smears?

Healthcare providers perform Pap smears as part of a pelvic exam. The test checks for:

What’s the difference between a pelvic exam and a Pap test?

During a pelvic exam, your healthcare provider examines and feels (palpates) the uterus, ovaries and other parts of the female reproductive system. This examination helps your provider identify infections, problems and certain types of cancer (but not cervical cancer). Your provider may also perform STD tests during a pelvic exam. A pelvic exam doesn’t always include a Pap smear.

What’s the difference between a Pap smear and a HPV test?

A HPV test checks for certain types of the virus that increase your cervical cancer risk. HPV is a common STD that affects approximately 79 million Americans. There are many different types of HPV. Not all cause cancer.

Providers can do HPV tests and Pap tests at the same time, using the same steps (a gentle scrape of the cervix for cell samples). When sending these samples to a lab, your provider specifies whether the lab specialist (pathologist) should check for precancerous or cancerous cells (Pap smear), HPV or both (a co-test).

Can a Pap smear detect STDs?

A Pap smear can’t detect STDs. To test for diseases like chlamydia or gonorrhea, your healthcare provider takes a sample of fluid from the cervix. Fluid isn’t the same as cervical cells. Blood tests can also identify certain STDs.

How often do I need a Pap smear?

Women and anyone assigned female at birth should start getting Pap smears starting at age 21 and HPV tests at age 30. How often you’ll have the test depends on many factors, including your age, health history and results from your last Pap or HPV test. Most people don’t need Pap smears after age 65.

Generally, Pap smears occur:

• Every three years from ages 21 to 29.
• Every three years from ages 30 to 65 without an HPV test.
• Every five years from ages 30 to 65 with an HPV test.
• Every year for those who have human immunodeficiency virus (HIV) or are immunocompromised.
• Every year for those whose mothers took a medicine called diethylstilbestrol (DES) during pregnancy. Exposure to DES while in the womb increases cervical cancer risk.

Do I need a Pap smear if I’ve had a hysterectomy?

A hysterectomy is a surgical procedure to remove the uterus. A partial hysterectomy removes the uterus but not the cervix. You’re still at risk for cervical cancer and need Pap smears.

Some people have a complete hysterectomy (removal of the uterus and cervix) due to a cancer diagnosis. In that case, you’ll continue getting Pap smears to look for changes that might indicate a cancer recurrence. If you had a complete hysterectomy to treat a noncancerous problem, such as uterine fibroids, you probably won’t need Pap smears.

Test Details

How should I prepare for a Pap smear?

Some things that you do in the days before a Pap smear can affect test results. For the most accurate results, you should:

• Not have vaginal sex for two days before your exam.
• Not use tampons, vaginal creams or medicines, birth control foams or jellies, lubricants or douches for at least two days before the test.
• Schedule the appointment at least five days after your period ends.

What should I expect during a Pap smear?

Pap smears take place at a healthcare provider’s office. The test takes a few minutes. It isn’t painful, but you may feel some discomfort. During the procedure, your healthcare provider:

• Inserts a speculum into the vagina. You may feel a bit of pressure. This metal or plastic device holds the vagina open so your provider can see the cervix.
• Uses a small brush or spatula to gently scrape cells from the cervix (a biopsy).

What should I expect after a Pap smear?

Your healthcare provider sends the samples to a lab. A specialist called a pathologist examines the samples under a microscope to look for abnormal cells that may indicate cancer or HPV.

Are there any risks to getting a Pap smear?

Pap smears are very safe. You may experience some light spotting (vaginal bleeding) after the test, but you shouldn’t have cramps or pain.

Results and Follow-Up

When should I get my test results?

It can take up to three weeks for your healthcare provider to receive the lab results.

What do Pap smear results mean?

When you receive your results, they may be:

• Normal: No sign of disease.
• Unclear: The lab couldn’t determine whether the cells are normal or abnormal. Your healthcare provider may have you come back immediately or in six months for another Pap smear.
• Abnormal: The cells look different than they should.

Does an abnormal Pap smear result mean that I have cervical cancer?

An abnormal finding means that some cells in your cervix look unusual. Many things besides cancer can cause an abnormal result, including:

What follow-up tests might I need after an abnormal Pap smear result?

If you have an abnormal Pap smear result, your healthcare provider may perform another Pap smear immediately or in a few months. A second Pap smear can be helpful if your healthcare provider thinks an infection or other problems affected the test results.

Pap smears only screen for cancer — they can’t diagnose it. To get more information to help diagnose or rule out cervical cancer, your provider does a colposcopy. During this procedure, your provider:

• Uses a microscope device (colposcope) to view the lining of the cervix and vagina.
• Removes tissue samples from areas that look abnormal.
• Sends the samples to a lab for testing.

Pap smears are a lifesaving screening tool. The test identifies abnormal cervical cells before they have a chance to become cancerous. More than 95% of the time, people treated for precancerous cells don’t develop cervical cancer. During a Pap smear, your healthcare provider may remove cells to test for HPV, a STD that increases your risk of cervical cancer. An unclear or abnormal Pap test result doesn’t mean you have cancer. Your provider can discuss test findings and next steps with you.

Abnormal Pap Smear Results: What Do They Mean and What Happens Next

When it comes to gynecological health, a Pap smear is one of the basic tests a lot of women are familiar with as part of their yearly exam. But what happens if you get an abnormal result? What does abnormal mean? And what happens after you get an abnormal result? We will help you with any questions specific to your case should this concern arise, but in general, this information will help you out.

What is a Pap Smear?

A Pap (Papanicalaou) test, or Pap smear, is a procedure used to collect cells from the cervix to be examined under a microscope to find cancerous and precancerous cells.

The test is performed by your health care professional placing a speculum (an instrument to keep the vagina open) inside the vagina so the cervix can be seen clearly. Then various samples are taken by the healthcare professional from the exocervix and endocervix. The samples are then prepared so they can be looked at under a microscope in the lab.

What Results Can You Get from a Pap Test

According to the Centers for Disease Control and Prevention, there are three ways that a Pap test result can come back.

1. Normal: Also referred to as “negative,” this result means that no cell changes were found on your cervix. Even with repeated normal results you still need to get Pap tests regularly.
2. Unclear: If the test comes back with an unclear result, your doctor may use terms like “equivocal,” “inconclusive,” or “ASC-US.” These terms all mean that your cervical cells look like they could be abnormal and it’s unclear if that’s related to HPV (human papillomavirus). HPV is the most common sexually transmitted infection and is usually harmless but some types can lead to problems like genital warts or cancer. Unclear results could be caused by things like pregnancy, an infection, or menopause. An HPV test can clarify these results.
3. Abnormal: This result means that cell changes were found on your cervix. An abnormal result does not mean you have cervical cancer. Usually, cell changes on the cervix are caused by HPV.

What Do Abnormal Pap Smear Results Mean?

As stated above, abnormal Pap smear results mean that the cells taken from your cervix show changes. Don’t panic, because this does not necessarily mean you have cervical cancer. Most cervical cell changes are caused by HPV.

These cell changes can be low-grade (minor) or high-grade (serious). Low-grade changes often return to normal given time. More serious changes have a higher risk of turning into cancer if they are not removed. Because they can turn into cancer but are not yet, these changed cells are called “pre-cancer. ”

In some rare cases, an abnormal Pap smear result can show you already have cervical cancer. Further testing is required to be sure and make a definitive diagnosis.

What Happens Next?

Again, it is important to remember that an abnormal Pap smear result does not necessarily mean you have cancer.

If your Pap smear results are abnormal, your doctor will probably ask if you’ve had an abnormal Pap smear result before. Even if you’ve had the same doctor for a while and they have your comprehensive medical history, they may still ask to confirm.

If you get an abnormal result from your Pap test, your doctor will likely take your specific results and age into account and follow guidelines set by the American Congress of Obstetricians and Gynecologists (ACOG) to decide which steps to take next. You might be given an HPV test. Based on the results of your HPV test, possibilities and treatment plans may differ.

Your doctor will give you another examination and take a closer look at your cervix. This is called a colposcopy. During the colposcopy, the doctor may take a sample of cells for further testing or take a biopsy. The procedure is mildly uncomfortable but generally well tolerated by most patients.  After this procedure the doctor may perform further testing on any collected samples and if need schedule a follow-up or discuss further plans.

Depending on your specific circumstances, after further examination, your doctor may need to remove the abnormal or precancerous cells to prevent them from becoming worse or progressing into cancer.

Another possibility is the doctor finding that you have cervical intraepithelial neoplasia, which is a growth that can lead to cancer on the cervical surface. In these cases, endocervical sampling is performed.

If pre-cancer or early cancer is detected, it should be removed as early as possible. There are two common procedures, two different types of cone biopsies, for these purposes:

• Loop electrosurgical procedure (LEEP or LLETZ): With this method, a thin wire loop is heated with electricity and is used like a small knife to remove the tissue. This procedure is done in your doctor’s office with the use of local anesthetic.
• Cold knife cone biopsy: Instead of the heated wire used in LEEP, a surgical scalpel or laser is used to remove the tissue. This procedure is done in a hospital and uses either general anesthesia or a spinal epidural.

Navigating confusing test results can be scary and daunting. At Kernodle OB/GYN, we are gynecological healthcare specialists that can help guide you through any concerns you may have about your health and wellbeing. If you have questions or want to schedule an appointment, call (336) 538-2367.

Abnormal Pap Smear – Epithelial Cell Abnormality

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.

90,000 PAP test – analysis for cervical dysplasia

Biomaterial

For this study, the laboratory accepts the following biomaterial:

• Scraping / discharge from the cervical canal (liquid)

Preparing for research

The conditions for preparation are determined by the attending physician.

Scraping of the urogenital tract (in women: cervical canal) : In women of reproductive age, it is recommended to take a smear not earlier than on the 5th day of the menstrual cycle and not later than 5 days before the expected start of menstruation.

Swabs should not be taken:

• before 48 hours after sexual intercourse;
• during menstruation;
• earlier than 48 hours after using suppositories and other substances containing fat, vinegar or Lugol’s solution, tampons or spermicides;
• after vaginal examination (pelvic ultrasound, colposcopy), douching;
• during the treatment of urogenital infections.

In the CMD laboratory, when ordering services 031212 and 031216 at the same time, the test “Coexpression of oncoproteins p16 / Ki67” is performed in the following cases:

• HPV test – positive (≥3 lg), PAP test – ≥ ASCUS (ASCUS / ASC-H / L-SIL / H-SIL)
• HPV test – 16/18/45 types identified (≥3 lg), PAP test – NILM
• HPV test – negative, PAP test ≥ H-SIL (CIN2 / 3)

In other cases, including in the case of a negative HPV test and NILM based on the results of the PAP test, co-expression is not performed and the study fee is not charged.

In case of additional ordering of the service 031216 to the already performed service 031212 the test “Coexpression of oncoproteins p16 / Ki67” is performed in any case, regardless of the results of the test “HPV-PAP-test liquid”

Laboratory research and diagnostics, prices for services

More than fifty years ago, Dr. Papanikolaou, after whose name the method (Pap test) was later named, developed a method for cytological examination of cells of the cervical canal by smear on glass.The RAR test is widely used in screening studies to diagnose cervical cancer, precancerous and background conditions. In the countries of northern Europe, where screening studies are well organized, the treatment of precancerous conditions and early forms of cancer has reduced mortality from invasive cervical carcinoma by 50 – 70%. At present, the identification of a risk group during cytological examination of cervical smears during preventive examinations and further observation makes it possible to catch the process of malignancy at the earliest stages.
A prerequisite for an accurate assessment of cell morphology in a smear is a correctly made and well-stained smear. The effectiveness of cytological diagnostics is largely determined by the quality of preparation of drugs. Currently, a new technology for the preparation of cytopreparations, the so-called liquid cytology, is becoming more and more widespread. An important technological feature of the liquid cytology (LC) method, which improves the quality of the study, is that the test material is taken into a special stabilizing solution, which ensures its safety without destruction and loss of cells.At the same time, all cellular material retains its morphological and immunocytochemical properties unchanged. This makes the opinion of a cytologist much more reliable in comparison with conventional smears, when the material is immediately applied to the glass.
Over the past five years, many studies have been conducted in different countries that compared the effectiveness of traditional techniques and life cycle, using histological examination as the “gold standard” and the assessment of cytopreparations according to the TBS (The Bethesda System) classification to confirm diagnoses. The study involved both outpatient and inpatient departments, which examined thousands of patients. According to the generalized data, the sensitivity of the traditional method varies over a wide range of values: 34.5 – 89%; and for the life cycle method it has more stable values: 71.4 – 95%. Accordingly, the specificity of the methods is a more reliable laboratory test, reduces the number of false negative results, reduces the number of drugs that are unsatisfactory for analysis and the time required for a cytologist to evaluate the drug.
Liquid cytology is recommended as the “gold standard” for examining smears from the mucous membrane of the cervical canal and the vaginal part of the uterus during screening and dispensary examinations of women with the aim of early diagnosis and prevention of cervical cancer.

Liquid cytology has a number of advantages over the traditional method of preparing a smear from the mucous membrane of the cervix, including:

• improved quality of the cytological smear;
• long shelf life of the obtained biomaterial due to a special solution PreservCyt, which prevents premature drying of cells;
• quick preparation of the drug;
• preparation of a standardized multilayer smear;
• the possibility of carrying out additional diagnostic methods (for example, HPV tests) without repeated gynecological examination.

Advantages and Disadvantages of Traditional Cytology and Liquid Cytology

Cytological screening for cervical cancer is recommended for all women between the ages of 25 and 65. Late detection of precancerous conditions and the lack of the necessary treatment can lead to the development of cervical cancer.

For 48 hours before the study, stop douching, the use of intravaginal therapy and vaginal contraceptives, sex, colposcopy using a solution of acetic acid or Lugol.

Pap test, or Pap smear: what is it and when to do

Therefore, regular check-ups are not only important, but also necessary in order to be able to target cancer when it is still in its early stages.

The first of these examinations is the Pap smear, which detects the presence of a tumor or precancerous lesions by examining the cells of the cervix.

This is a simple, quick and painless test that is used by a healthcare professional to detect viral, bacterial or fungal infections.

What is cervical cancer?

Cervical cancer is caused by the papilloma virus (HPV), which is sexually transmitted.

Infection does not necessarily lead to the development of a tumor, since the body is able to fight the virus in about 90% of cases, and the presence of cellular changes does not necessarily indicate the presence of cancer.

However, there remains a 5% chance that mucosal changes caused by HPV infection will develop into cancer.

This is a long process that can take up to ten years, and therefore a Pap smear is essential to early detection of precancerous lesions and prevent them from developing into cancer.

Thus, when we talk about the Pap test, we are talking about a fundamental preventive tool that detects precancerous lesions that do not cause any visible symptoms in patients at an early stage of the disease.

For this reason, the Pap test saves the lives of many women every year and is considered the first screening test for the early diagnosis of cervical cancer.

When to have a Pap smear?

There is no specific age at which it is recommended to take the first Pap test: in fact, it is a test related to the patient’s sexual activity and, therefore, it is usually recommended two years after the first intercourse.

A healthy patient who has no risk factors and has never tested positive for HPV can have a Pap smear every three years.

Those with a history of HPV or identified risk factors should have regular annual check-ups.

In any case, it is always recommended to follow the advice of your specialist, who can indicate the best way forward, including with regard to the patient’s medical history.

During the three days preceding the Pap test, the patient should refrain from sexual activity, as the presence of residual sperm can affect the reliability of the result.

Eggs and vaginal douching, which tend to obscure the presence of cellular changes, should also be avoided, while oral contraceptives and intrauterine devices are not contraindicated.

The Pap test cannot be performed during menstruation, therefore the patient is advised to indicate the window between the two menstrual flows when booking.

During the periovulatory period, a larger number of cells are taken for research.

Women who have gone through the first trimester of pregnancy may also have a Pap test.This is a non-hazardous test and does not pose a risk to the fetus or mother.

Pap test: how is it done?

Pap test is a simple examination that lasts a few minutes, does not cause pain (at best, mild discomfort) to the patient and is performed as part of a routine gynecological examination.

The gynecologist separates the cervix with a dilator, a special goose beak instrument, and removes cells from the cervix with a thin stick.

The cells are then fixed on a suitable glass slide and sent to the laboratory for analysis. The result usually comes in 10-15 days.

What does a Pap test result mean?

If the Pap smear result is negative, it means that the sample did not show any cellular changes and that the patient can be examined again within the time specified by the specialist (as we said, usually from 1 to 3 years. ).

If, on the other hand, the Pap smear is positive, this means that there are cellular abnormalities and that the patient will need to undergo an additional examination, an HPV test, which is performed as a simple vaginal smear and determines the presence of viral DNA in the genital tract.

HPV test confirms HPV infection but does not detect the presence of a tumor.

Read also:

Transvaginal ultrasound: how it works and why it is important

US CDC Study: “No Increased Risk of Miscarriage for Pregnant Women with Covid Vaccine”

source:

Humanity

Cytology analysis

Daniil Davydov

medical journalist

Author’s profile

Cytological analyzes are any examination of human cell samples under a microscope.They help detect precancerous changes, cancer and sometimes viral cell infection.

In this article we will talk about cytological analyzes of cells from biological material obtained from the surface of the cervix. This test helps to suspect cervical cancer and to take action before the disease becomes incurable. This is very important because cervical cancer is the fifth most common cancer in Russia.

Why does cervical cancer develop

The lower part of the cervix that opens into the vagina is called the ectocervix.It has an opening, or external pharynx, that opens into the endocervical canal – the inside of the cervix.

Where does cervical cancer develop – a textbook for laboratory technicians PDF, 17.7 MB

Ectocervix covers several layers of cells called squamous epithelium. The key task of squamous epithelium is to protect the cervix from mechanical damage during sex, from loss of moisture and pathogenic microbes.

The inner part of the cervix, the endocervical canal, is lined with prismatic epithelium.Some prismatic cells have cilia, while others secrete mucus. The cilia help the sperm travel down the mucus pathway to reach their destination, the uterus.

The place where the squamous epithelium meets the prismatic epithelium is called the transformation zone. This is where most of the cancer cells that can cause cervical swelling appear. The main reason why cancer develops here is due to the fact that human papillomaviruses, or HPV, prefer to live in flat cells from the transformation zone.

Cancer develops in the transformation zone – on the border between prismatic and squamous epithelium

If two people infected with different types of HPV have sex, each partner may end up with two types of the virus. If you use a condom, the likelihood of getting infected decreases, but still remains.

14 types of HPV are known that belong to the group of high oncogenic risk. These viruses can turn off genes in healthy host cells that prevent them from becoming cancerous.Among human papillomaviruses, types 16 and 18 are the most dangerous – they cause cancer most often.

Approximately 10-20% of cervical cancers are associated with altered cells of the prismatic epithelium – it is called adenocarcinoma. This type of cancer is associated with HPV in only 15–38% of cases. Why non-HPV adenocarcinoma occurs is still not fully understood.

Other forms of cervical cancer, for example, those associated with both squamous and prismatic epithelium, are very rare – in about 1% of cases.

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How dangerous is cervical cancer

In our country, in the structure of mortality from cancer, cervical cancer ranks tenth – this is 4.7% of deaths among cancer patients. In 2018, 6392 women died from him.

Russian clinical guidelines for the prevention and treatment of cervical cancer, 2020 PDF, 731 KB

Moreover, experts note that young women 35-59 years old began to die more often.From 1997 to 2018, mortality rates in this group increased by 85.2%. It is difficult to say for what reasons this happened: perhaps doctors simply learned to make this diagnosis more accurately.

Fortunately, cells in the transformation zone do not immediately turn into cancerous cells. HPV-affected epithelial cells begin to change about 10-15 years before cancer develops. These changes can be detected and corrected – and then the development of cancer can be avoided.

Who is at risk of getting cervical cancer

A procedure called screening helps to determine the susceptibility to cervical cancer.Typically, screening includes one or more tests or examinations that are done to large groups of people without symptoms of a particular disease. This helps to understand whether this person is at risk of getting sick and how great he is.

Cervical Cancer Screening – Bulletin of the American College of Obstetricians and Gynecologists

Cervical Cancer Screening Works – Cancer Consultation International Patient Organization Bulletin

Screening for cervical cancer is very effective.Since 1991, when Australia introduced a national screening program for cervical cancer, the number of women who have died from this cancer has halved.

Until 2017, Australian screening included only a cytological screening test, which was offered to all women between 18 and 70 years of age. After 2017, the cervical cancer control program was supplemented with mandatory HPV vaccination and HPV testing was added to the program. Comprehensive measures have reduced the incidence so dramatically that now representatives of the Australian Ministry of Health hope that by 2068, doctors will make this diagnosis less than once a year.

What tests include screening for cervical cancer

As a rule, two tests are used for screening for cervical cancer: this is either an analysis for the human papillomavirus, or a cytological examination of the cervix, which is also called a Pap test or a Pap smear, or both.

High-risk HPV assay by polymerase chain reaction, or PCR. Since women who are not infected with HPV rarely get cervical cancer, the analysis helps to understand whether a particular woman is at risk and how high the risk is.Modern PCR tests can distinguish all 14 types of the most dangerous HPV from each other and determine whether there are among them the most dangerous viruses – types 16 and 18.

What to do? 11.11.20

Are papillomas dangerous and how can they be picked up?

Cytological examination of scraping of the cervix and cervical canal. In the twenties of the last century, an American physician of Greek origin Georgios Papanikolaou discovered that the transformation of normal cells of squamous or prismatic epithelium into cancerous ones begins with small but noticeable changes in their structure, which can be seen under a microscope after special staining.In honor of Papanicolaou, this study was called the Pap test.

Pap smear under a microscope. Large pink epithelial cells are normal, while small blue-violet cells may be precancerous. Scienceline

Today, instead of the classic Pap test, an improved version of it is often used, which is called the examination of the scraping of the cervix and the cervical canal by liquid cytology, or simply the Pap test by liquid cytology.

Pap test and liquid cytology testing complement the HPV test, because they can detect not only squamous cell carcinoma, but also adenocarcinoma, even if it is not associated with HPV.

Who needs to be screened and when

Women under the age of 25 have almost no cervical cancer. Therefore, all healthy women in most countries of the world are advised to undergo screening for this disease from the age of 25 to 65, inclusive.

Cancer Screening Guidelines by Age – American Cancer Society Bulletin

As a rule, abroad it is advised to start with an HPV test. If he did not identify any problems, in the future it will need to be taken once every five years.But if he detects HPV types 16 and 18, the doctor will refer the patient for a cytological examination. Therefore, some women prefer to take the material immediately for both the HPV test and the cytological examination.

If we restrict ourselves only to cytological research, the analysis will have to be repeated more often – once every three years.

This approach is almost the same as the screening program for cervical cancer in other parts of the world. But there is one caveat.

The research carried out in state laboratories as part of the clinical examination is not as accurate as the methods adopted abroad.In such laboratories, the smear is stained according to Romanovsky-Giemsa. This method is simpler and cheaper than a Pap smear, but it does not reveal some important features in the structure of cells.

What are cervical cancer screening tests – Uptodate

A more accurate result is given by the classic Pap smear and the study of scraping of the cervix and cervical canal by liquid cytology. But these tests can only be taken in a private laboratory for money.But if you take the analysis by liquid cytology, the same sample can be sent for cytology and for HPV testing. When tests are done in one place, it allows you to get the result faster. On average, it will take one to three weeks to wait for the result.

The price of screening for cervical cancer in Moscow – from 4600 R

Sampling of biomaterial from the cervix

Examination of scraping of the cervix and cervical canal by liquid cytology

Analysis for HPV of high carcinogenic risk

Sampling of biomaterial from the cervix

395 R

Examination of scraping of the cervix and cervical canal by liquid cytology

Analysis for HPV of high carcinogenic risk

Sampling of biomaterial from the cervix

440 R

Examination of scraping of the cervix and cervical canal by liquid cytology

Analysis for HPV of high carcinogenic risk

Some laboratories offer to undergo a comprehensive examination for cervical cancer, which includes all the necessary tests.The complex can be cheaper than taking the tests separately. For example, the laboratory “Helix” offers to undergo screening for 6810 R, including sampling of biomaterial.

How to prepare for screening

Both for HPV analysis and for cytological examination, biological material is required, which is collected with a soft brush and a flat plate with rounded edges – it is called a spatula. In order for the cells of both squamous and prismatic epithelium to enter the sample, material is taken from both the inner and outer surfaces of the cervix.The procedure takes a few minutes.

The result of the analysis largely depends on the quality of the material. You can increase the accuracy if you follow simple rules:

1. Do not donate biomaterial during your menstrual cycle. Otherwise, blood may enter the sample and the test will have to be retaken.
2. Do not have sex, douche, or use vaginal medications, spermicidal foams, or creams two days before the test. These can all wash away or hide abnormal cells.

How to Prepare for Collection – Mayo Clinic

How to deal with the results of cytological analysis

It is not possible to diagnose cervical cancer on the basis of screening tests. All that a cytological study can do is to show whether there are changes in epithelial cells and how serious they are. WHO recommends that physicians describe these changes in accordance with the Bethesda International Classification, or TBS.

Cervical cancer develops over the years, and this is reflected by cytological analysis.Source: “Cancer-info”

NILM , or negative for intraepithelial lesion or malignancy, in translation – negative for intraepithelial lesions or malignant neoplasms. Russian doctors usually write in the results form: “Cytogram without features.” Everything is in order with the cells of the cervix, nothing needs to be done. Repeated cytological analysis will need to be done in three years. If you took the test along with an HPV test that did not reveal dangerous types of the virus, you can take the next test after five years.

Bethesda classification of the third revision PDF, 22.6 MB

What do the results of a cytological study mean – recommendations for doctors PDF, 321 KB

ASC-US , or atypical squamous cells of undetermined significance, translated as atypical squamous cells of undetermined significance. The sample contains altered squamous cells, but most likely they are not dangerous. In this situation, you need to repeat the study six months later.

LSIL , or low-grade squamous intraepithelial lesion, in translation – squamous intraepithelial lesion of low malignancy.The sample contains altered squamous epithelial cells, but there are few of them. The appearance of these cells is associated with either inflammation or HPV. This corresponds to the first degree of cervical intraepithelial neoplasia, or CIN 1: when altered cells are found in less than a third of the thickness of the cervical lining.

In this situation, you need to repeat the study six months later. If re-examination confirms the suspicion, the altered cells can be removed – this will help prevent cancer.

ASC-H , or atypical squamous cells cannot exclude HSIL, in translation – atypical squamous cells, HSIL cannot be excluded.The sample contains altered squamous cells, they can be dangerous, and there can be many of them.

In this situation, the doctor should send for additional research. This is a colposcopy, in which the doctor examines the vagina and the outside of the cervix with a colposcope, and a biopsy – when the doctor takes a tissue sample from the cervical region for examination. Further actions depend on the results of these analyzes.

HSIL , or high-grade squamous intraepithelial lesion, in translation – high-grade squamous intraepithelial lesion.The sample contains altered squamous epithelial cells, and there are quite a few of them. It can match:

1. CIN 2 – when altered squamous epithelium cells are found in a third to two-thirds of the thickness of the cervical membrane;
2. CIN 3 – when there are altered squamous epithelium cells throughout the thickness of the cervical membrane;
3. CIS – probable intraepithelial cancer of the cervix without metastases.

The physician should refer the patient for colposcopy and biopsy.If the diagnosis is confirmed, treatment will be required.

SCC , or squamous cell carcinoma, in translation – squamous cell carcinoma. Most likely, this is squamous cell carcinoma of the cervix. The doctor should refer the patient for colposcopy and biopsy to clarify the stage and choose the appropriate treatment.

AGC , or atypical glandular cells, in translation – atypical glandular cells. The sample contains altered prismatic epithelial cells of unknown origin.This can speak of benign neoplasms like polyps, and squamous cell carcinoma or adenocarcinoma. The doctor should refer the patient for colposcopy and biopsy. If the suspicion is confirmed, treatment will be required.

What in the end

1. Cytology tests are the classic Pap test and the Pap test using liquid cytology.
2. Cytology tests, along with HPV testing, are part of the cervical cancer screening program. This is a massive research program that helps detect suspicious cells in women without any special symptoms in time and take action before the disease develops.
3. All sexually active women over 25 are at risk of developing cervical cancer. Therefore, from this age up to 65 years, it makes sense to be screened every 3-5 years.
4. In Russia, you can take a Romanovsky-Giemsa smear free of charge as part of a clinical examination once every three years. But this test is not as reliable as the classic Pap test or the liquid cytology Pap test. More reliable results can be obtained by taking a Pap test in a private clinic for money.

Pap test not for dads, but for moms

Many have heard of the modern gynecological examination, which is called the PAP test (or Papanicolaou cytology) and has a high reliability of the results.Only not everyone knows for what purpose the analysis is being done and to whom it is shown. LabStory gynecologists are ready to share this important information.

Of course, the PAP test has nothing to do with testing paternity. It has a different diagnostic significance. This is a smear taken from the cervix.

A century ago, the Greek geneticist Papanikolaou became famous throughout the world for having learned to recognize uterine cancer at a stage when the tumor had not yet formed and it could not be detected by any other diagnostic methods.A hundred years have passed, and the relevance of the test has not decreased.

Of course, many are familiar with the vaginal smear. Usually it is taken for research on flora. Here the task is different – to detect or exclude cancer. A cervical swab is a scraping of epithelial cells that is applied to laboratory glass and sent to a laboratory where a doctor analyzes the cells for signs of cancer. However, the smear has serious errors and about 40% of the results give false negative results.

Pap test is a cytology test for abnormal cells that is performed using several smear staining methods. This allows you not to miss the presence of changes in the cells taken from the cervix.

Now about the main thing.

Who needs to do the test and how often in order not to miss cancer?

• All women need to start with the onset of sexual activity and be examined annually so as not to fall into the risk group for cervical cancer.Moreover, it is very convenient to combine a visit to a gynecologist with a PAP study of .
• If there are irregularities in the cycle, menstruation is absent for a long time, they are too scarce or, conversely, abundant, erosion and other gynecological diseases are detected – then PAP test is performed twice as often – once every six months.
• With the same frequency, it is necessary to do research for all whose women in the family have had cancer of the uterus or ovaries.
• And, of course, Pap test must be performed in pregnant women, and even better during the period when you are just planning to conceive a child.

Many people ask the question: PAP test and cytology are different analyzes?
It seems that there, and there, the identification of malignant and cells close to them. At the same time, PAP is twice as expensive.

They are looking for the same thing, but with different methods.

The material for the study is a cytological smear. The algorithm for its diagnosis is the same as for a conventional cytological examination. However, a different fixation and staining method is used for the PAP study .The sample that has just been applied to the glass is quickly fixed with alcohol. After that, a series of stains is performed. Wet fixation allows you to keep the cells unchanged, which contributes to their better differentiation.

The receipt of hand test results may vary depending on the institution where the woman was screened. In public medical institutions, the waiting time can be from 1 to 2 weeks, when taking tests at LabStory, the results of a PAP smear can be collected in a few days.

Having received the results in her hands, a woman should contact her gynecologist in order to decipher them. It is possible to independently read and understand what the screening results indicate, but there are fears that if the patient is misinterpreted, the patient will miss precious time.

90,000 Liquid cytology in Moscow – do a study of cervical scraping at a gynecologist at an affordable price

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Doctors gynecologists

One of the most accurate methods for diagnosing malignant neoplasms on the cervix is ​​liquid cytology. Unlike standard cytology, this analysis makes it possible to evaluate three times the number of cells from the cervix and increase the accuracy of the study up to 98%.You can take a study in Moscow at the Kutuzovsky Medical and Diagnostic Center.

Liquid cytology – what is it

Cytology is the science of the development, reproduction, and functioning of cells. The liquid cytology method is a study that involves taking a scraping from suspicious areas on the cervix and further examining them under a microscope. The solution is processed in a centrifuge, where possible contaminants are removed and cyto-preparations with cells located in a uniform layer are obtained.This is what increases the accuracy of the result obtained in comparison with other methods.

The analysis can be found under synonymous names: Pap test, smear for oncocytology or Pap smear, Pap smear.

The purpose of liquid cytology is to detect pathological conditions dangerous for precancerous degeneration on the mucous membrane in the early stages.

Benefits

Screening with liquid cytology allows for a more informative study and determines the presence of human papillomaviruses in the body.

Liquid cytology has a number of advantages over other studies:

• Ability to detect the presence of HPV in the body, and determine its amount.
• Finding the p16INK4a protein, which can serve as an indirect sign of transformation in the cells of the cervix.
• High accuracy of cell imaging, thanks to a solution that allows you to clean epithelial cells from traces of contamination. This allows the most complete preservation of the biological properties of the samples.
• Independence of the received answer from temperature fluctuations.
• Possibility to carry out PCR tests during the procedure.

Who needs cytology

Examination of the scraping of the cervix and cervical canal is recommended for all women as a screening method for cervical cancer. This is the third most common type of oncology in women (only breast and colon cancer is more common). Disease of cervical cancer occurs in about 15-25 cases per 100 thousand population.The disease more often occurs in middle-aged patients (in the period 35-55 years), less often in women aged 65 years and older, in isolated cases in patients under 20 years of age.

According to international medical recommendations, to undergo screening and take a smear for oncocytology costs:

• All girls under 21 or 3 years after the onset of sexual activity.
• Once every 2-3 years from the age of 30 to 65.
• Every year for patients at risk.

Risk factors for this type of tumor:

• Infection with papillomavirus (some of its HPV types are especially oncogenic).
• Genital herpes.
• Chronic inflammation of the organs of the reproductive system.
• Immunodeficiency or weakening of immunity due to chemotherapy, severe illnesses.
• Early onset of sexual activity and frequent change of sexual partners.
• Family history – cases of this type of cancer in close relatives.
• HIV infection.
• Hypovitaminosis (deficiency of vitamins A and C).

Also indications for cytological examination are:

• Menstrual irregularities – delays, too long or too short a cycle.
• Preparation for pregnancy or suspected infertility.
• Long course of hormonal therapy.
• Gynecological pathologies of an infectious nature: genital warts, herpes and other diseases.
• The appearance of uncharacteristic discharge.

Liquid Cytology Results

When performing analyzes, many criteria are taken into account. For an informative study, an amount of material is required, which contains a certain number of cells of the corresponding type.Scraping should contain cells of different types: squamous epithelium, endocervix, metaplastic cells. Otherwise, there is no way to draw conclusions about pathological changes.

The research result is interpreted as follows:

• The test is considered negative if the epithelial cells are within the normal range, the indicators correspond to age norms.
• There are changes of a benign nature – there are cells of a non-tumor type, there are signs of an inflammatory process (the number of leukocytes is increased), infection (an increased number of rods, Trichomonas, yeast and other cells).
• There are changes in squamous epithelial cells that require additional examination: the presence of atypical cells, squamous cell lesions of varying degrees, cervical neoplasia of varying degrees, carcinoma or squamous cell carcinoma.
• Identified atypical glandular cells (in this case, additional examination is required).

Even minimal changes in epithelial cells and the receipt of suspicious test results are grounds for testing for oncogenic HPV serotypes.

False positive results can be found in young girls (up to 20 years old) due to possible changes in the epithelium against the background of hormonal disruptions.

Preparation and implementation of cytology

Taking a smear is carried out during a gynecological examination. With a special brush, the doctor partially scrapes material from the upper layer of the cervical canal and cervix for further analysis in the laboratory. The results will be ready in a few days.

The procedure is quick and painless, the mucous membrane is not injured.The patient needs preliminary preparation:

• Abstaining from sexual intercourse 2-3 days before analysis.
• Refusal from douching, the use of vaginal suppositories, gels, ointments, anti-inflammatory vaginal tablets.
• Refusal to use tampons.
• Abstaining from urination 2-3 hours before the analysis.

Liquid cytology is one of the laboratory tools for determining pathological processes in the cervix.Its results cannot become the basis for the diagnosis of cervical cancer, but should prompt a more thorough examination with such techniques as extended colposcopy, biopsy and others. Their results are complex and can be considered a reliable sign of a malignant tumor.

Cytological diagnostics and other diagnostic services are available at the Kutuzovsky Medical Center. Modern equipment, a wide range of laboratory tests, doctors of various specialties to interpret the results and prescribe the necessary treatment.

You can clarify the details of interest and sign up for a doctor’s consultation by calling the clinic: +7 (495) 478-10-03.

Work schedule:

• 8:00 to 20:00 Monday to Friday.
• From 9:00 to 21:00 on Saturday and Sunday.

Address of the medical center: Moscow, st. Davydkovsky, 5.

Promotion! Discount 20% on the first appointment for new patients of the clinic with the promo code “FIRST20”.

90,000 What is an abnormal smear?

Abnormal Pap smear is a Pap smear that shows irregularities when viewed under a microscope by a laboratory technician. Abnormal Pap smears are not uncommon, and many women experience at least one abnormal result in their lifetime. There are a number of causes for an abnormal Pap smear, and while the result should be corrected, it should not be seen as a cause of immediate panic.

Although the Pap smear is used primarily as a screening test for early signs of cervical cancer, an abnormal Pap result does not necessarily mean a woman has cancer. A lot of things can cause changes in the cells of the cervix, ranging from inflammation to sexually transmitted infections. It is important to decide on an abnormal Pap test to find out why the result was abnormal before deciding on the next step.

In addition to detecting signs of cervical cancer, Pap smears can also be abnormal due to yeast infection, irritation, inflammation, human papillomavirus (HPV) infection, or infection with other sexually transmitted infections.If the laboratory returns abnormal results to your doctor, he or she usually recommends a follow-up examination to discuss the results. After talking with you, your doctor may decide to have another Pap test, test for sexually transmitted infections, or prescribe medication to treat a yeast infection or inflammation. If he or she is particularly concerned, a colposcopy may be recommended. In a colposcopy, a doctor examines the cervix, vagina, and labia with a powerful microscope to identify irregularities and take samples for biopsies.

Usually, the lab doesn’t just say that the Pap smear was “abnormal,” it describes the type of abnormality observed. Many laboratories rate abnormal results from one to five, with the least serious of these, and fives of concern. An abnormal pap smear can also cause symptoms such as atypical squamous or glandular cells, or low or high grade squamous intraepithelial lesions. All of these terms describe specific types of cellular changes that can be observed.