Cervical screening tests results can be confusing and a bit stressful. Even having the screening done can cause some worry. I see a lot of patients for abnormal cervical screening test results and explaining what it means is a big part of that (even before we talk about what to do!).
Cervical screening in Australia has changed for the better. Because we understand more about cervical cancer and how it happens, we have been able to design a screening test and pathway that allows us to better identify people at increased risk of cancer and who need treatment, people who are at risk and we should watch carefully, and people are are low risk.
What the test is looking for
The Cervical Screening Test looks for human papillomavirus (HPV) — a very common virus that causes almost all cervical cancers.
HPV is spread through skin-on-skin contact. It is so common that most sexually active people will have HPV at some point in their lives, and in the majority of cases it clears naturally without causing problems.
There are over 200 types of HPV. Most of these are low risk for causing cervical cancer or cause genital warts. There are some subtypes that can cause cervical cancer and this is what the cervical screening test is looking for.
Importantly, having HPV does not mean you have cancer.
For HPV to cause cervical cancer the HPV infection needs to be persistent (ie. your body doesn’t clear it), cause cell changes on the cervix, and those cell changes are left untreated and progress to cancer. This takes time – between 10-20years – and that means we have time to let your body clear the infection and watch carefully if it doesn’t.
Your result: what it means
1. Low risk (HPV not detected)
- No HPV was found
Your risk of developing significant cervical changes is very low. You will be recommended to have routine screening again in 5 years.
2. Intermediate risk (HPV detected, not types 16/18)
- A type of HPV was found, but not the highest risk types
- There are either no cell changes or only minor changes
If the sample was self-collected, cell changes cannot be assessed. A doctor-collected sample, usually with your GP, will help to determine the risk level and appropriate next steps.
In most cases the body clears this infection naturally, so your doctor will normally recommend retesting in 12 months. However, if the HPV infection persists, then you will be referred to a specialist for a colposcopy.
3. Higher risk (HPV 16/18, high grade cell changes found)
- High risk HPV types were found, or
- Higher-grade cell changes are suspected
Your doctor will likely recommend that you see a specialist for a colposcopy.
A colposcopy is a closer examination of the cervix. It does not mean cancer is present, but allows earlier detection and treatment if needed.
If the sample was self-collected, the doctor-collected sample will be obtained during colposcopy with the specialist, this is because a specialist referral will be required regardless of cell changes.
4. Unsatisfactory result
This means that the sample couldn’t be assessed properly. A repeat the test is recommended (usually within weeks).
What to expect at colposcopy
If you are referred for a colposcopy, it is understandable to feel anxious. In practical terms, it is very similar to having a cervical screening test:
- A speculum is inserted so the cervix can be seen
- The doctor uses a colposcope (a microscope outside the body) to examine the cervix more closely
- A liquid is applied to highlight any abnormal areas
- Small samples (biopsies) may be taken for further testing
Key points:
- The colposcope does not go inside the body
- The procedure is usually brief
- Most findings are not cancer and, if treatment is needed, it is often straightforward
Why follow-up matters
Cervical cancer develops slowly and screening is designed to detect HPV and early cell changes well before cancer develops.
Attending recommended follow-up tests is the key step that keeps you safe.
Symptoms to be aware of
Most early cervical cell changes cause no symptoms, which is why screening is so important.
However, you should seek advice if you notice:
- Bleeding after sex
- Bleeding between periods or after menopause
- Unusual vaginal discharge
- Pelvic pain
Final message
- HPV is common and usually temporary
- Abnormal results are common
- Cervical cancer is largely preventable through screening and vaccination programs
If you are unsure what your result means, or would like it explained in the context of your own history and situation, arrange a review — this is where tailored advice makes a difference.
