An abnormal cervical screening test result can be concerning, but understanding what it means is the first step towards effective management. Early detection and treatment of a cervical problem can lead to excellent outcomes.
A cervical screening test (CST), previously known as a Pap smear, is a test that looks for the presence of human papilloma virus (HPV) or changes in the cells of your cervix. Prevention of cervical abnormalities primarily revolves around regular screening and HPV vaccination. The Australian government recommends that all women aged 25-74 years participate in the National Cervical Screening Program by undergoing routine screening every five years. The HPV vaccination is offered free to students in the first years of high school under the National Immunisation Program.
The cervical screening test is primarily designed to enable the early detection and treatment of changes that can lead to cervical cancer, which is critical for improving health outcomes.
The primary cause of cervical abnormalities is persistent infection with high-risk HPV strains. HPV is a very common skin virus in the sexually active population and is usually cleared from the body by your immune system within 3-5 years. If HPV infection is persistent, it may cause cell changes that can lead to cancer in the future if left untreated. The process where cell changes develop into cancer is very slow and can take years to happen, but usually the HPV virus is cleared before the cells develop into cancer.
A CST does not diagnose cervical cancer, and the presence of HPV does not mean that you have or will develop cancer, nor does finding abnormal cells automatically mean you have cancer.
You may undertake your regular cervical screening in Melbourne with your GP or another service such as a women’s health or sexual health clinic. Low-risk women (those without symptoms suspicious of cervical cancer), may also opt to self-collect a sample in an appropriate clinical setting.
If your CST returns a positive result for a certain strain of HPV or abnormal cells, your primary care provider will refer you to a gynaecologist for colposcopy and specialist care.
In its early stages, a cervical abnormality typically does not present with any symptoms, underscoring the importance of regular cervical screening tests.
As the cervical changes advance, symptoms may include:
Though these symptoms are not unique to cervical cancer, it is important to be assessed promptly by your GP or gynaecologist if you experience any of the above.
A colposcopy is a diagnostic test performed by a gynaecologist to confirm the presence of cervical cell changes. It is commonly done to further investigate abnormal cell changes identified during a cervical screening test. If pre-malignant changes are confirmed, treatment can be offered before the problem has had a chance to develop into cancer, allowing you to avoid cervical cancer altogether.
Colposcopy can also be used for:
A colposcope is a magnifying scope that looks at your cervix to closely examine abnormal cells when investigating abnormal cervical screening or suspected cervical pathology.
Similar to your CST, a colposcopy is performed while you lie on your back with your legs supported in stirrups. Dr Huang will insert an instrument to widen the opening of the vagina so your cervix is visible with the colposcope, which will be positioned just outside your vagina.
Your cervix will be stained with a mild acetic acid (vinegar) and iodine solution to show up abnormal cells. You may feel some slight stinging or burning sensation as the acid solution is applied.
A biopsy (small sample) may be taken of the abnormal tissue and sent away for pathological diagnosis.
A colposcopy takes around 15 minutes and does not usually need anaesthesia. Colposcopies may be accompanied by some period-like cramping but are typically well tolerated. To facilitate thorough examination, you should not have your period at the time of colposcopy.
The treatment for cervical abnormalities depends on several factors, including the severity of the abnormality, the presence of HPV, age, and whether you hope to have children in the future. Dr Huang will discuss her recommendation for you, which will be tailored to your risk factors and family plans.
Close monitoring is appropriate for minor changes that might return to normal on their own. This is suitable for low-grade cervical cell abnormalities. Your body works to clear HPV on its own, and typically achieves this within 3-5 years. However, living a lifestyle that supports healthy immune function can facilitate more rapid clearance, including not smoking, getting regular exercise, and eating a well-balanced diet rich in antioxidants.
For more significant, high-risk abnormalities, treatments may involve removing or destroying the abnormal tissue.
In cases where pre-cancerous cells are found, or if you have been diagnosed with early-stage cervical cancer, more extensive surgical procedures may be necessary to remove all areas of abnormal growth. The most common surgical treatment for cervical cancer is a radical hysterectomy, which removes the uterus, cervix, upper vagina, and also often the fallopian tubes, to prevent the cancer cells from spreading.
