Cervical cancer screening is one of the most effective tools we have for preventing cervical cancer. Pap tests and HPV testing help identify abnormal cells and HPV infections before they develop into cancer, allowing for monitoring or treatment when needed.
Cervical cancer screening looks for high-risk HPV infection and abnormal changes in the cells of the cervix before they develop into cervical cancer. Regular screening is very effective at identifying these changes early, when they can be monitored or treated.
There are two main types of cervical cancer screening:
A Pap smear test (cytology) looks for abnormal cells on the cervix.
An HPV test looks for high-risk types of human papillomavirus that can cause cervical precancer and cancer.
Depending on your age and medical history, screening may involve a Pap test, HPV testing, or both. Most people do not need cervical cancer screening every year. The appropriate interval depends on your age, the type of testing performed, and your previous results.
Some people need a different screening schedule, including those with a history of significant cervical precancer or cervical cancer, certain immune conditions, or previous abnormal screening results. Your recommended screening schedule should therefore be based on your individual history.
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Human papillomavirus (HPV) is extremely common, and most sexually active people will be exposed to HPV at some point in their lives. Most HPV infections are cleared or controlled by the immune system without causing health problems.
Certain high-risk types of HPV can cause changes in cervical cells. When a high-risk HPV infection persists over time, these changes can occasionally progress to cervical precancer and, if not identified and treated when appropriate, cervical cancer. This process usually develops gradually, which is why routine cervical cancer screening is so effective.
A positive HPV test does not mean that you have cervical cancer, and it usually cannot tell us when you were exposed or from whom. HPV can remain undetectable for years before becoming detectable again, so a positive test does not necessarily represent a new infection.
The HPV vaccine protects against the HPV types responsible for most cervical cancers, as well as several other HPV-related cancers and genital warts. It works best when given before HPV exposure, but vaccination may still provide protection against HPV types you have not previously encountered.
The HPV vaccine prevents new HPV infections but does not treat an HPV infection that is already present. If you have not completed the HPV vaccine series, talk with your healthcare provider about whether vaccination is recommended or may still be beneficial for you.
This is one of the most common questions I hear after a positive HPV test. Unfortunately, there is currently no medication that directly eliminates HPV from the body. In most people, the immune system eventually controls the infection on its own, and HPV becomes undetectable. Most new HPV infections become undetectable within about 1–2 years.
While there is no proven way to make HPV disappear faster, I generally encourage habits that support overall immune and cervical health:
Don't smoke. Smoking is associated with a greater risk of persistent HPV and progression of cervical abnormalities.
Take care of your overall health. Adequate sleep, regular physical activity, a nutritious diet, and managing stress are good for general health and immune function, although none has been proven to specifically clear HPV.
Reduce new HPV exposures when possible. Limiting the number of sexual partners and using condoms can reduce the chance of acquiring or transmitting HPV, although condoms cannot provide complete protection because HPV is spread through skin-to-skin contact.
Keep up with recommended follow-up. Repeat HPV/Pap testing, colposcopy, or treatment when indicated allows us to identify and manage cervical cell changes while your immune system has time to control the infection.
What about AHCC?
AHCC (Active Hexose Correlated Compound) is a mushroom-derived supplement that has been studied as a possible way to support the immune response to persistent high-risk HPV. One small randomized controlled trial in women with HPV that had persisted for more than two years found promising results with AHCC taken daily for six months. However, the study was small, and additional research is needed before we can know how effective it is.
AHCC is not an established or guideline-recommended treatment for HPV, and it should not replace recommended cervical cancer screening, colposcopy, or treatment of cervical precancer. For patients with persistent HPV who are interested in trying a supplement, I think it is reasonable to discuss the potential benefits, limitations, cost, and possible medication interactions.
An abnormal cervical cancer screening result usually does not mean that you have cervical cancer. Results may show HPV infection, mildly abnormal cervical cells, or changes that have a higher likelihood of developing into precancer over time.
The recommended next step depends on your current result and your previous screening history. Depending on your individual risk, we may recommend repeating testing after a period of time or performing a colposcopy to look more closely at the cervix.
Pap test results describe changes seen in cells collected from the cervix and may use terms such as ASC-US, LSIL, or HSIL. If a colposcopy and biopsy are performed, the biopsy provides a tissue diagnosis and may use different terms, such as CIN 1, CIN 2, or CIN 3. These results help us estimate the likelihood that cervical changes could progress over time and determine whether monitoring or treatment is appropriate.
HPV and Pap Test Results: Next Steps after an Abnormal Cervical Cancer Screening Test (NCI)
Understanding Abnormal Pap Smear Results (White Coat Mama, video)
Unsatisfactory Pap Test
Sometimes a Pap test does not collect enough cells for the laboratory to reliably interpret the sample. This is called an unsatisfactory Pap test. It does not mean that abnormal or cancerous cells were found. Usually, we will recommend repeating the Pap test to obtain a better sample. An unsatisfactory result can occur for several reasons, including a small number of cells in the sample, inflammation, bleeding, or changes related to menopause.
Endometrial Cells on a Pap Test
Occasionally, a Pap test may detect endometrial cells, which are cells from the lining of the uterus. This does not necessarily mean that anything is abnormal. These cells can normally appear on a Pap test, particularly in people who are still having menstrual periods.
Whether additional evaluation is recommended depends on factors such as your age, whether you have reached menopause, and whether you are experiencing abnormal bleeding. If further evaluation is appropriate, your doctor may recommend an endometrial biopsy, a brief office procedure that collects a small sample of the uterine lining for examination.
A colposcopy is a procedure used to look more closely at the cervix after certain abnormal Pap or HPV test results. During the procedure, the cervix is examined under magnification and small biopsies may be taken if an area looks abnormal.
If you've been scheduled for a colposcopy, the guide below explains how to prepare, what to expect during the procedure, and what recovery is typically like.
If a biopsy is taken during colposcopy, the pathology report may describe cervical intraepithelial neoplasia (CIN). CIN refers to precancerous changes in the cells of the cervix. CIN is not cervical cancer, and not all CIN requires treatment.
CIN 1 (low-grade dysplasia) represents mild cell changes. These changes are often caused by HPV infections that the immune system will eventually control, so CIN 1 can usually be monitored rather than treated.
CIN 2 and CIN 3 (high-grade dysplasia) represent more significant abnormal cell changes that have a greater chance of progressing over time. Depending on your age, pregnancy plans, previous results, and other factors, CIN 2 may sometimes be monitored carefully, while CIN 3 generally requires treatment.
When treatment is recommended, the goal is to remove the abnormal area before it has the opportunity to progress to cervical cancer. The most common treatment is a LEEP (Loop Electrosurgical Excision Procedure). In some situations, a cold knife cone biopsy (conization) may be recommended instead.
→ Cold Knife Cone Biopsy: What to Expect