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  • Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?

Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?

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 to 12 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 to 12 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 become 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. ASC-US changes are not likely to develop into cervical cancer.

Your choices of what to do next include:

  • Watchful waiting with a follow-up Pap test in about 6 to 12 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.

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:

Compare your options

Compare

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 to 12 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.

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 about 6 months to 12 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.

Indira, age 34

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 about 12 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 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.

April, age 29

I had an abnormal Pap test in my early 20s. My doctor 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 exam 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 doctor 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.

Margaret, age 32

I'm studying overseas for 3 months, so I had my regular gynecologic examination and Pap test at the student health clinic before I left. 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.

Aisha, age 22

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.

Connie, age 32

I had a Pap test and found out I have something called atypical squamous cells of undetermined significance (ASC-US). My doctor told me that I could wait and have another Pap test in a few months to see if I may need treatment or I could have a colposcopy. I'm getting ready to go back to college, and I don't want to worry that something might be wrong. So I've decided to have the colposcopy.

Paola, age 21

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?

Check the facts

1.

Do most minor cell changes go away on their own?

  • YesThat's right. Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
  • NoSorry, that's not right. Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
  • I'm not sureIt may help to go back and read "Get the Facts." 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?

  • YesThat's right. More severe changes aren't likely to occur during a short period of watchful waiting.
  • NoSorry, that's not right. More severe changes aren't likely to occur during a short period of watchful waiting.
  • I'm not sureIt may help to go back and read "Get the Facts." 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?

  • YesThat's right. Some types of HPV can increase your risk of getting cervical cancer.
  • NoSorry, that's not right. Some types of HPV can increase your risk of getting cervical cancer.
  • I'm not sureIt may help to go back and read "Get the Facts." 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
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.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. 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.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. 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 to 12 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 to 12 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 become 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. ASC-US changes are not likely to develop into cervical cancer.

Your choices of what to do next include:

  • Watchful waiting with a follow-up Pap test in about 6 to 12 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.

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 to 12 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 about 6 months to 12 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."

— Indira, age 34

"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 about 12 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 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."

— April, age 29

"I had an abnormal Pap test in my early 20s. My doctor 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 exam 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 doctor 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."

— Margaret, age 32

"I'm studying overseas for 3 months, so I had my regular gynecologic examination and Pap test at the student health clinic before I left. 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."

— Aisha, age 22

"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."

— Connie, age 32

"I had a Pap test and found out I have something called atypical squamous cells of undetermined significance (ASC-US). My doctor told me that I could wait and have another Pap test in a few months to see if I may need treatment or I could have a colposcopy. I'm getting ready to go back to college, and I don't want to worry that something might be wrong. So I've decided to have the colposcopy."

— Paola, age 21

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?

  • Yes
  • No
  • I'm not sure
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?

  • Yes
  • No
  • I'm not sure
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?

  • Yes
  • No
  • I'm not sure
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.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

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
  1. 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.

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