You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?
Get the facts
Your options
- Have colposcopy.
- Don't have colposcopy. Instead,
have a follow-up Pap test in about 6 months or get an HPV (human papillomavirus) test to see if you have a type
of HPV that can increase your risk of getting cervical cancer.
Key points to remember
- Most minor cell changes go away on their own and don't cause
problems. And they are not usually cancer.
- You may decide to wait
and have another Pap test in about 6 months to see if the changes have gone
away. More severe changes aren't likely to occur during a short period of
watchful waiting.
- If you're not
comfortable waiting, you may decide to have colposcopy. This test allows your
doctor to take a closer look at the abnormal cells and find out if treatment is
needed.
- Minor cell changes may be caused by
HPV infection. You can get an HPV test—if you haven't
already had one—to find out if you have a type of HPV that can increase your
risk of getting cervical cancer. If you have one of these types, colposcopy is
recommended.
FAQs
Colposcopy is a test that can
find abnormal cells on your
cervix,
vulva, and
vagina.
During the exam, your doctor uses
a magnifying device called a
colposcope. This device allows your doctor to see
problems that might be missed by the naked eye. If a problem is seen during the
exam, your doctor may take a small piece of tissue (biopsy) from
your cervix to take a closer look at the cells.
Colposcopy may be
done after a Pap test shows that you have minor cell changes on your cervix. An
abnormal Pap test means that the test found some cells on your cervix that
don't look normal. It doesn't mean that you have cancer. In fact, the chances
that you have cancer are very small.
All abnormal Pap tests require some kind of follow-up to
be sure that the cell changes haven't gotten worse or have returned to
normal.
If you have
atypical squamous cells of undetermined significance (ASC-US) cell changes, there are several follow-up options you can
choose from. Most of the time, ASC-US cell changes stay the same or return to
normal on their own. Women with ASC-US changes are not likely to get
cervical cancer.
Your choices of what to
do next include:
- Watchful waiting with a follow-up Pap test in about 6
months or as often as your doctor suggests. More severe cell changes aren't
likely to occur during this time. More than half of all minor cell changes
return to normal on their own.
- AnHPV test—if you haven't already
had one—to find out if you have a type of HPV that can increase your risk of
getting cervical cancer. If you already had this test during your initial Pap
test, your doctor can tell you the results. If you don't have a high-risk type
of HPV, no further testing is recommended. But if you have a high-risk type of
HPV:
- Colposcopy is recommended to see how
severe the cell changes are.
- It doesn't mean that minor cell
changes will progress to cancer, because HPV infections can go away on their
own.
- Colposcopy if you:
- Are not comfortable waiting and want to
know right away if you may need treatment.
- Have certain risk
factors, such as a high-risk type of HPV infection or a
weakened immune system.
- Are not able to
return for a follow-up Pap test.
If you're pregnant and have ASC-US cell changes, your
choices are the same as those for women who aren't pregnant.
Most of the time,
colposcopy is not advised for:
- Women who have gone through menopause,
because a natural decrease in
estrogen levels is likely to cause minor cell
changes.
- Teenage girls, because minor cell changes and HPV
infection are more likely to go away on their own. And it's very rare that
girls this age get cervical cancer.
Instead, a period of watchful waiting and repeat Pap
tests are tried first.
Colposcopy is usually not painful, but it may cause some mild cramping.
The tool (speculum) used to spread open your vagina is in place longer than
during a routine pelvic exam. This may cause some discomfort.
A
biopsy may be done at the time of colposcopy. You may
feel a brief, sharp pain or have some cramping while this is done.
After the test you may:
- Have vaginal bleeding and
discharge.
- Be sore.
- Get an infection. But this is very
rare.
Your
doctor may recommend colposcopy if:
Compare your options
| | |
|---|
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
| |
Have colposcopy
Have colposcopy
- You lie on your back with your
feet raised and supported by footrests while your doctor uses a magnifying
device called a colposcope to look at your
vulva,
vagina, and
cervix.
- Photos or videos of your vagina
and cervix may be taken.
- If your doctor sees a problem, he or she
will take a small piece of tissue (biopsy) from
your cervix to check for problems.
- You may feel some discomfort and mild cramping, but colposcopy
usually isn't painful.
- During a biopsy, you may feel a brief, sharp
pain or have some cramping.
- Colposcopy and a cervical biopsy can be
done in your doctor's office.
- Colposcopy and a cervical biopsy
can:
- Let you know right away if there is a more serious problem
and whether you may need treatment.
- Show abnormal cells that can't
be seen by the naked eye.
- Detect cervical cancer.
- Help
rule out cervical cancer.
- Possible side
effects after a cervical biopsy include:
- Vaginal bleeding and
discharge.
- Soreness.
- Infection. But this is very
rare.
Don't have colposcopy
Don't have colposcopy
- You have a follow-up Pap
test in about 6 months or as often as your doctor suggests to see if the
abnormal cells have returned to normal.
- You may have an
HPV test to see if minor cell changes are caused by a
type of HPV that can cause more severe cell changes and cervical cancer.
- You avoid the cost of
colposcopy.
- You avoid the risks of having colposcopy and a cervical
biopsy.
- The abnormal cells may return to normal on their
own.
- If you start to worry and don't want to wait any longer, you
can decide later to have colposcopy.
- Minor cell
changes may become more severe.
- If you don't have colposcopy, you
won't know right away if the cell changes may be the kind that are more likely
to turn into cancer and that need to be treated.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
I was
finishing school, starting a new job, and planning a wedding when the women's
clinic called and said my Pap test was abnormal, with minor cervical cell
changes called atypical squamous cells of undetermined significance (ASC-US).
She says I do not have any high-risk factors for cervical cancer and that
waiting 4 to 6 months to follow up would be fine. I feel comfortable with her
recommendation and have so much to do right now that watchful waiting feels
okay.
I started worrying as soon as my doctor
called and said my Pap test was abnormal. She said the results showed only
minor cervical cell changes called atypical squamous cells of undetermined
significance (ASC-US). I could follow up with another Pap test in 4 to 6
months. But I had just heard about a woman at my health club who was diagnosed
with cervical cancer and is now undergoing treatment. With that fresh on my
mind, I knew I couldn't wait 4 to 6 months to see if everything was okay. So I
asked my doctor what else we could do. She said we could schedule a colposcopy
examination as follow-up rather than waiting.
I had an
abnormal Pap test in my early 20s. My health professional at the time explained
that an abnormal Pap is common in young, sexually active women. My tests have
all been normal now for several years. I recently changed jobs and moved, so I
didn't have a routine examination for almost 2 years. Now I have another
abnormal Pap test, and the results classify the cell changes as ASC-US
(atypical squamous cells of undetermined significance). My new health
professional explained that further testing for high-risk human papillomavirus
(HPV) types may determine how serious these cell changes are and help me decide
what to do next. Because of my past health, it sounded reasonable to find
out more. The HPV test was negative, which made me feel better. Now I only need
follow-up Pap tests to monitor the cell changes.
I'm
studying overseas for 3 months, so I had my regular gynecologic examination and
Pap test at the student health clinic before leaving. The results showed minor
cervical cell changes called atypical squamous cells of undetermined
significance (ASC-US). The health clinic nurse said that these changes are not
usually treated and that follow-up Pap tests are usually all they recommend to
monitor the minor cell changes. She reassured me that watchful waiting would be
appropriate and told me to come back for a follow-up Pap test after I return
home in 4 to 6 months.
My health
professional just called with the results of my routine Pap test. I have some
minor cervical cell changes classified as atypical squamous cells of
undetermined significance (ASC-US). I've had sexually transmitted infections
before, so I knew I might be at risk for an abnormal Pap test. He recommended
that I have testing for the human papillomavirus (HPV) to determine if I have a
high-risk HPV type. Further testing, such as repeat Pap tests or a colposcopy,
will depend on the HPV test result. Since my husband and I want to start a
family soon, it will be best to follow up now so we know what we're dealing
with.
I just had my first Pap test and found out
I have cervical cell changes called low-grade squamous intraepithelial lesions
(LSIL). My doctor says most women with these cell changes should have a
procedure called a colposcopy to take a closer look at the cells. But since I'm
still a teenager, the abnormal cells will probably not get worse. Instead of a
colposcopy, I will have another Pap test in 4 to 6 months.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have colposcopy
Reasons not to have colposcopy
I'm worried that the abnormal cells may turn into cancer.
I want to wait and see if the abnormal cells return to normal on their own.
More important
Equally important
More important
I'm not afraid to have a biopsy if my doctor sees a problem during the colposcopy.
I don't want to have a colposcopy or biopsy if I don't need to.
More important
Equally important
More important
I'm not worried about how much colposcopy costs.
I don't have insurance, and I can't afford to pay for the test myself.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having colposcopy
NOT having colposcopy
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1.
Do most minor cell changes go away on their own?
2.
Is it okay to wait a while to see if the abnormal cells return to normal on their own?
3.
Can HPV infection cause minor cell changes to get worse?
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Credits | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
|---|
References
Citations
- American College of Obstetricians and Gynecologists
(2010). Management of abnormal cervical cytology and histology. ACOG Practice
Bulletin No. 99. Obstetrics and Gynecology, 112(6):
1419–1444.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Have colposcopy.
- Don't have colposcopy. Instead,
have a follow-up Pap test in about 6 months or get an HPV (human papillomavirus) test to see if you have a type
of HPV that can increase your risk of getting cervical cancer.
Key points to remember
- Most minor cell changes go away on their own and don't cause
problems. And they are not usually cancer.
- You may decide to wait
and have another Pap test in about 6 months to see if the changes have gone
away. More severe changes aren't likely to occur during a short period of
watchful waiting.
- If you're not
comfortable waiting, you may decide to have colposcopy. This test allows your
doctor to take a closer look at the abnormal cells and find out if treatment is
needed.
- Minor cell changes may be caused by
HPV infection. You can get an HPV test—if you haven't
already had one—to find out if you have a type of HPV that can increase your
risk of getting cervical cancer. If you have one of these types, colposcopy is
recommended.
FAQs
What is colposcopy?
Colposcopy is a test that can
find abnormal cells on your
cervix,
vulva, and
vagina.
During the exam, your doctor uses
a magnifying device called a
colposcope. This device allows your doctor to see
problems that might be missed by the naked eye. If a problem is seen during the
exam, your doctor may take a small piece of tissue (biopsy) from
your cervix to take a closer look at the cells.
Colposcopy may be
done after a Pap test shows that you have minor cell changes on your cervix. An
abnormal Pap test means that the test found some cells on your cervix that
don't look normal. It doesn't mean that you have cancer. In fact, the chances
that you have cancer are very small.
What are your choices after a Pap test shows minor cell changes?
All abnormal Pap tests require some kind of follow-up to
be sure that the cell changes haven't gotten worse or have returned to
normal.
If you have
atypical squamous cells of undetermined significance (ASC-US) cell changes, there are several follow-up options you can
choose from. Most of the time, ASC-US cell changes stay the same or return to
normal on their own. Women with ASC-US changes are not likely to get
cervical cancer.
Your choices of what to
do next include:
- Watchful waiting with a follow-up Pap test in about 6
months or as often as your doctor suggests. More severe cell changes aren't
likely to occur during this time. More than half of all minor cell changes
return to normal on their own.
- AnHPV test—if you haven't already
had one—to find out if you have a type of HPV that can increase your risk of
getting cervical cancer. If you already had this test during your initial Pap
test, your doctor can tell you the results. If you don't have a high-risk type
of HPV, no further testing is recommended. But if you have a high-risk type of
HPV:
- Colposcopy is recommended to see how
severe the cell changes are.
- It doesn't mean that minor cell
changes will progress to cancer, because HPV infections can go away on their
own.
- Colposcopy if you:
- Are not comfortable waiting and want to
know right away if you may need treatment.
- Have certain risk
factors, such as a high-risk type of HPV infection or a
weakened immune system.
- Are not able to
return for a follow-up Pap test.
If you're pregnant and have ASC-US cell changes, your
choices are the same as those for women who aren't pregnant.
Who may not need colposcopy?
Most of the time,
colposcopy is not advised for:
- Women who have gone through menopause,
because a natural decrease in
estrogen levels is likely to cause minor cell
changes.
- Teenage girls, because minor cell changes and HPV
infection are more likely to go away on their own. And it's very rare that
girls this age get cervical cancer.
Instead, a period of watchful waiting and repeat Pap
tests are tried first.
What are the side effects or risks of colposcopy?
Colposcopy is usually not painful, but it may cause some mild cramping.
The tool (speculum) used to spread open your vagina is in place longer than
during a routine pelvic exam. This may cause some discomfort.
A
biopsy may be done at the time of colposcopy. You may
feel a brief, sharp pain or have some cramping while this is done.
After the test you may:
- Have vaginal bleeding and
discharge.
- Be sore.
- Get an infection. But this is very
rare.
Why might your doctor recommend colposcopy?
Your
doctor may recommend colposcopy if:
2. Compare your options
| | Have colposcopy
| Don't have colposcopy
|
|---|
| What is usually involved? | - You lie on your back with your
feet raised and supported by footrests while your doctor uses a magnifying
device called a colposcope to look at your
vulva,
vagina, and
cervix.
- Photos or videos of your vagina
and cervix may be taken.
- If your doctor sees a problem, he or she
will take a small piece of tissue (biopsy) from
your cervix to check for problems.
- You may feel some discomfort and mild cramping, but colposcopy
usually isn't painful.
- During a biopsy, you may feel a brief, sharp
pain or have some cramping.
- Colposcopy and a cervical biopsy can be
done in your doctor's office.
| - You have a follow-up Pap
test in about 6 months or as often as your doctor suggests to see if the
abnormal cells have returned to normal.
- You may have an
HPV test to see if minor cell changes are caused by a
type of HPV that can cause more severe cell changes and cervical cancer.
|
|---|
| What are the benefits? | - Colposcopy and a cervical biopsy
can:
- Let you know right away if there is a more serious problem
and whether you may need treatment.
- Show abnormal cells that can't
be seen by the naked eye.
- Detect cervical cancer.
- Help
rule out cervical cancer.
| - You avoid the cost of
colposcopy.
- You avoid the risks of having colposcopy and a cervical
biopsy.
- The abnormal cells may return to normal on their
own.
- If you start to worry and don't want to wait any longer, you
can decide later to have colposcopy.
|
|---|
| What are the risks and side effects? | - Possible side
effects after a cervical biopsy include:
- Vaginal bleeding and
discharge.
- Soreness.
- Infection. But this is very
rare.
| - Minor cell
changes may become more severe.
- If you don't have colposcopy, you
won't know right away if the cell changes may be the kind that are more likely
to turn into cancer and that need to be treated.
|
|---|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
Personal stories about treating minor cervical cell changes
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was finishing school, starting a new job, and planning a wedding when the women's clinic called and said my Pap test was abnormal, with minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). She says I do not have any high-risk factors for cervical cancer and that waiting 4 to 6 months to follow up would be fine. I feel comfortable with her recommendation and have so much to do right now that watchful waiting feels okay."
"I started worrying as soon as my doctor called and said my Pap test was abnormal. She said the results showed only minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). I could follow up with another Pap test in 4 to 6 months. But I had just heard about a woman at my health club who was diagnosed with cervical cancer and is now undergoing treatment. With that fresh on my mind, I knew I couldn't wait 4 to 6 months to see if everything was okay. So I asked my doctor what else we could do. She said we could schedule a colposcopy examination as follow-up rather than waiting."
"I had an abnormal Pap test in my early 20s. My health professional at the time explained that an abnormal Pap is common in young, sexually active women. My tests have all been normal now for several years. I recently changed jobs and moved, so I didn't have a routine examination for almost 2 years. Now I have another abnormal Pap test, and the results classify the cell changes as ASC-US (atypical squamous cells of undetermined significance). My new health professional explained that further testing for high-risk human papillomavirus (HPV) types may determine how serious these cell changes are and help me decide what to do next. Because of my past health, it sounded reasonable to find out more. The HPV test was negative, which made me feel better. Now I only need follow-up Pap tests to monitor the cell changes."
"I'm studying overseas for 3 months, so I had my regular gynecologic examination and Pap test at the student health clinic before leaving. The results showed minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). The health clinic nurse said that these changes are not usually treated and that follow-up Pap tests are usually all they recommend to monitor the minor cell changes. She reassured me that watchful waiting would be appropriate and told me to come back for a follow-up Pap test after I return home in 4 to 6 months."
"My health professional just called with the results of my routine Pap test. I have some minor cervical cell changes classified as atypical squamous cells of undetermined significance (ASC-US). I've had sexually transmitted infections before, so I knew I might be at risk for an abnormal Pap test. He recommended that I have testing for the human papillomavirus (HPV) to determine if I have a high-risk HPV type. Further testing, such as repeat Pap tests or a colposcopy, will depend on the HPV test result. Since my husband and I want to start a family soon, it will be best to follow up now so we know what we're dealing with."
"I just had my first Pap test and found out I have cervical cell changes called low-grade squamous intraepithelial lesions (LSIL). My doctor says most women with these cell changes should have a procedure called a colposcopy to take a closer look at the cells. But since I'm still a teenager, the abnormal cells will probably not get worse. Instead of a colposcopy, I will have another Pap test in 4 to 6 months."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have colposcopy
Reasons not to have colposcopy
I'm worried that the abnormal cells may turn into cancer.
I want to wait and see if the abnormal cells return to normal on their own.
More important
Equally important
More important
I'm not afraid to have a biopsy if my doctor sees a problem during the colposcopy.
I don't want to have a colposcopy or biopsy if I don't need to.
More important
Equally important
More important
I'm not worried about how much colposcopy costs.
I don't have insurance, and I can't afford to pay for the test myself.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having colposcopy
NOT having colposcopy
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1.
Do most minor cell changes go away on their own?
That's right. Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
2.
Is it okay to wait a while to see if the abnormal cells return to normal on their own?
That's right. More severe changes aren't likely to occur during a short period of watchful waiting.
3.
Can HPV infection cause minor cell changes to get worse?
That's right. Some types of HPV can increase your risk of getting cervical cancer.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
|---|
References
Citations
- American College of Obstetricians and Gynecologists
(2010). Management of abnormal cervical cytology and histology. ACOG Practice
Bulletin No. 99. Obstetrics and Gynecology, 112(6):
1419–1444.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Last Revised:
December 28, 2010
American College of Obstetricians and Gynecologists
(2010). Management of abnormal cervical cytology and histology. ACOG Practice
Bulletin No. 99. Obstetrics and Gynecology, 112(6):
1419–1444.