Cervical Cancer Screening

“Your cervix looks different this year”

“Your cervix looks different this year,” said my primary care doctor several years ago, as she performed the pelvic exam part of my annual exam. I remember chuckling to myself, not fully grasping the severity of her comment yet. Instead, I laid on the table thinking, “How does she remember what my cervix looks like from year to year?”

My doctor referred me to a gynecologist when the exam was over. I didn’t understand, but I also didn’t ask any questions. I visited the gynecologist two days later. She performed a colposcopy and referred me to an oncologist. Two days after that, I met with the oncologist and he told me that I had stage 2B cervical cancer. What started out as a routine exam had quickly turned into a life-threatening diagnosis.

What if…? What if…? What if…?

How could I have cervical cancer? I didn’t feel sick. I had no symptoms. (Cervical cancer symptoms can include, but are not limited to, abnormal vaginal discharge, bleeding between periods, or pelvic pain during intercourse.) I went to my doctor every year for my annual well-woman exam and the results of my Pap tests always came back normal. But somehow, in the span of only one year, a 4 cm tumor had grown on my cervix. In one year, I went from having a normal Pap test result to having cancer. What a difference one year can make.

I started chemotherapy and radiation treatment to save my life. Doctors declared me cancer-free after I completed these treatments over the course of a few months. Today, I am a seven-year cervical cancer survivor. But my story could have been drastically different if I had skipped my well-woman exam that year.

What if I had used an excuse, like “I’m too busy”, to justify putting off that appointment? Or what if I had told myself that skipping one year wouldn’t hurt anything because I’m a generally healthy person? What if I had assumed my Pap test results would continue to be normal like they always had been? How much longer would my cancer have gone undetected? How far would my cancer have spread without my knowing? Would my prognosis have been different if my cancer wasn’t detected when it was? Would I even be alive today?

The importance of annual visits and cancer screenings

A cancer diagnosis is life changing. A cancer screening is lifesaving. Scheduling my annual exam saved my life. My cancer was detected early enough to be effectively treated because I went to my doctor every year.

If I had not scheduled my exam that year, my cancer would have continued to grow undetected and my life would have been at risk.

Preventative care exams are a breast exam, pelvic exam, and a Pap (and HPV) test. A Pap test looks for abnormal cells. If needed, these can be treated before they become cancerous. The HPV test looks for high-risk HPV that can cause abnormal cells. This lets your healthcare provider monitor you more closely for cell changes.. When the Pap test and HPV test are both performed during an exam, it is referred to as co-testing.

What are you waiting for?!

  • Reduce your risk for cervical cancer through screening tests, like the Pap test and HPV test.
  • Take care of yourself by scheduling your annual well-woman exam.
  • Raise awareness for cervical cancer detection and prevention by telling your family and friends to schedule their annual well-woman exams.
  • Benefit from Iowa’s Care for Yourself program, which provides free or low-cost cancer screenings for Iowans. Many other states have free or low-cost cancer screening programs too. Be sure to visit your state or county health department’s website.
  • Make a resolution to protect your health all year long.

About the Author

Emily Hoffman is a seven-year cervical cancer survivor who was diagnosed with stage 2B cervical cancer at age 30. She is a patient advocate and Cervivor Ambassador who shares her cancer story to raise awareness for cervical cancer and educate others on the importance of cancer screenings and prevention. Emily is the recipient of the 2020 Cervivor Spark Award. She is currently pursuing her certification to become a cancer registrar.

Your Pap Test Came Back “Abnormal”. Now What?

Nobody looks forward to getting a Pap test, but we women get them regularly – or SHOULD get them regularly because Pap tests are crucial to preventing cervical cancer. We at Cervivor want to make sure that women understand what a Pap test does, what it is looking for and what “abnormal” results may mean. Afterall, if your Pap results came back abnormal, it is important to understand what that means and what steps to take next. 

What exactly is a Pap test?

A Pap test looks for abnormalities and precancerous cell changes in the cervix. If not treated, these abnormal cells could lead to cervical cancer.

Each year, more than 50 million Pap tests are performed in the U.S. to screen for cervical cancer. An estimated 3 million of these Pap tests (5%) are read as abnormal. In fact, approximately 20% of American women have had at least one abnormal Pap test result in their lifetimes, though in the majority of cases, the abnormal cells are the result of a bacterial or yeast infection and are not pre-cancerous or cancerous. While less than 1% of abnormal Paps result in a cervical cancer diagnosis, up to 1 million Paps find early, potentially pre-cancerous cells that can be easily removed before they progress. This is why follow-up of abnormal Pap results is critical!

Pap test results will come back to your doctor as either:

  • Normal. The cells collected from your cervix during the Pap test look like they should.
  • Unclear. If results are unclear, your doctor may do more testing right away to rule out any problems, or your doctor may have you come back in 6 months or a year for another Pap test.
  • Abnormal. The cells collected from your cervix during your Pap test look abnormal. The first thing to keep in mind: abnormal Pap test results do not mean you have precancer or cancer. Sometimes the changed cells are due bacteria or yeast. But important follow-up tests will need to be done to get more information. 

What are some of the follow-ups for abnormal Pap test results?

You may need more tests to find out if you have an HPV infection and/or to find out how severe the cell changes are. For example, your doctor may do:

  • An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix to see if the abnormalities were caused by infection with any of the types of human papillomavirus that are linked to cervical cancer. 
  • Another Pap test in about 6 to 12 months (“watchful waiting”).
  • A colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool. 

What does a colposcopy look for?

A colposcopy is when a microscope (colposcope) with a strong light will be used to look at your cervix. Hundreds of thousands of colposcopies are performed in the U.S. each year. If any abnormal areas are identified, the doctor may take a small sample of tissue (“biopsy”)  from the cervix for closer examination. A biopsy is similar to a small pinch in terms of sensation and shouldn’t be too painful. The purpose of a biopsy is to confirm whether your screening test has been correct in identifying a problem. 

The colposcopist will usually be able to tell straight away if there are abnormal cells in your cervix, but biopsy results can take a few days to a few weeks to receive. 

Understanding the Language Used to Describe Cervical Cell Abnormalities

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. Pap and biopsy results reports commonly use these terms to report the severity of cell changes:

  • Mild: ASC-US or ASC-H. These are changes for which the cause is unknown. ASC-US (atypical squamous cells of undetermined significance) changes usually stay the same or return to normal. ASC-H (ASC that cannot exclude high-grade squamous intraepithelial lesions) changes are also minor but have a higher likelihood of becoming more serious. 
  • Mild: LSIL (low-grade squamous intraepithelial lesions). These changes, also known as CIN 1 (cervical intraepithelial neoplasia) are mild but may be more likely to become more severe over time, though could return to normal. 
  • Moderate to Severe: HSIL and AGC: These moderate to severe cell changes require follow-up. HSIL (high-grade squamous intraepithelial lesions) and atypical glandular cells (AGC) may also be referred to as CIN II and CIN III are more likely to be precancerous and turn into cervical cancer if left untreated.
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Treatments to remove abnormal, precancerous cells:

The good news is, abnormal or precancerous cells can be removed from your cervix. Your doctor will likely recommend one of the following procedures:

  • LEEP (loop electrosurgical excision procedure): A thin, low-voltage electrified wire loop is sued to cut out abnormal cervical cells. 
  • Laser or “cold-knife” conization (also referred to as a cone biopsy): A laser or scalpel (“cold-knife”) removes a cone or cylinder-shaped piece of the cervix.
  • Laser therapy: A tiny beam of high-intensity light vaporizes and destroys abnormal cells.
  • Cryotherapy: A very cold probe freezes and destroys abnormal cells.

There is a wealth of information out there from the American College of Obstetricians & Gynecologists, from the Foundation for Women’s Cancer and of course, from Cervivor. 

As a community of cervical cancer survivors, we encourage you to stay calm, ask questions, and be diligent about your follow-up testing.