What are minor cervical cell changes?
cervical cell changes classified on a Pap test as
atypical squamous cells of undetermined significance (ASC-US) or
low-grade squamous intraepithelial lesions (LSIL) are
cell changes that have not progressed to more severe abnormalities. They are
usually caused by inflammation or
What causes cervical cell changes?
cell changes are caused by
human papillomavirus (HPV). Other types of
infection-such as those caused by bacteria, fungi (yeast), or protozoa
(Trichomonas)-may cause ASC-US. Natural cervical cell
changes (atrophic vaginitis) related to
menopause can also cause an abnormal Pap test.
Smoking has been identified as a factor that may increase your risk of
developing abnormal cervical cell changes and cervical cancer.
What are the risks of not monitoring minor cervical cell changes?
Some minor cervical cell changes could, over a long
period of time, progress to severe cell changes or cervical cancer, which would
require more medical treatment. Follow-up testing to monitor minor cervical
cell changes will show whether abnormal cells persist or are progressing to
severe cell changes, and appropriate treatment can be done.
What are my follow-up options?
Even though most
abnormal Pap tests are caused by HPV infection, which usually goes away on its
own, you will need follow-up evaluation to make sure your minor cell changes
Your choices for what to do next for
ASC-US changes are:
- Watchful waiting with follow-up Pap
tests every 4 to 6 months. Women with ASC-US changes are not likely to develop
cervical cancer. More than half of all minor cervical
cell changes become normal on their own. Watchful waiting is usually
recommended if you can follow through with repeat Pap tests.
- HPV test to identify high-risk (positive) HPV types. Even if you have a
high-risk HPV type, it may never develop more severe cell changes. High-risk
HPV infections can also go away on their own. If your test is positive for
high-risk HPV, your doctor most likely will recommend colposcopy for further
evaluation. If the test is negative, you can go back to a regular
Pap test schedule.2
- Colposcopy. You may want more evaluation of the minor
cell changes right away if you:
- Are not able to return for
- Have several risk factors.
- Are not
comfortable with watchful waiting.
If the results of your Pap test show LSIL:
- Your doctor may recommend a
colposcopy to evaluate the cell
- Some women, especially those who have already gone through
menopause, may be treated for atrophy with estrogen cream and then have a
repeat Pap test. Colposcopy is needed only if the repeat test shows cell
- Watchful waiting may be recommended if you are an
adolescent girl. Adolescent girls who have a Pap test that shows ASC-US or LSIL
will usually have a repeat Pap test in 6 to 12 months. This is because girls
this age are extremely unlikely to develop cervical cancer, and HPV is likely
to go away on its own. But if either of the follow-up tests are abnormal,
colposcopy is usually the next recommended test.3
What are the side effects or risks of these choices?
If you choose watchful waiting, you will need follow-up Pap tests every 4
to 6 months. It is unlikely, but more severe cervical cell changes could
develop during the watchful waiting period. You may worry during the watchful
waiting time and may prefer the certainty of having the cell changes evaluated
by colposcopy and possibly a cervical biopsy. Or you may be comfortable waiting
and prefer to avoid a biopsy procedure.
A colposcopy exam can be
done in your doctor's office. It usually is not painful, but it may cause some
mild cramping. The instrument used to spread open the sides of the vagina
(speculum) is in place longer than during a routine gynecologic exam, which may
cause discomfort. Your doctor will be able to tell you what the visual exam
shows. The skill of your doctor in doing a colposcopy exam can affect the
accuracy of the exam. A colposcopy will be recommended if abnormal Pap test
results persist. A cervical biopsy may be done at the time of
What special circumstances affect my options?
you have any of the following special circumstances, your choices may be
different and your doctor can help you decide what is appropriate for
- Menopause. A short
treatment period with intravaginal estrogen therapy may be a choice if you are
postmenopausal with ASC-US cell changes. A natural decrease in estrogen levels
occurs after menopause and may be the cause of your abnormal cervical cell
changes. A repeat Pap test after estrogen therapy would determine if treatment
was successful or if further treatment is needed because ASC-US changes are
- A weakened (impaired) immune system. Colposcopy is recommended if you have ASC-US cell changes and an
impaired immune system because your cell changes may
be more likely to be identified as severe changes than in women with normal
- Pregnancy. If you are
pregnant and have ASC-US cell changes, your choices for watchful waiting or
further evaluation are the same as for nonpregnant women. Further treatment
will be delayed until after delivery unless cervical cancer-which is very rare
with minor ASC-US cell changes-is found. If cervical cancer is diagnosed,
specialized care for a high-risk pregnancy will be needed.
- Adolescence. If you are a teenager, minor cell changes are
even more likely to go away without treatment. Colposcopy generally is not
recommended as a first step.
Should I have HPV testing?
HPV test can identify high-risk (positive) HPV types.
Even if you have a high-risk HPV type, it may never develop more severe cell
changes. High-risk HPV infections can also go away on their own.
If you choose HPV testing for ASC-US, you may require a second pelvic exam if
cells for HPV testing were not collected or liquid-based cytology was not used
at the time of the initial Pap test. If your test is positive for high-risk
HPV, your doctor will recommend colposcopy for further evaluation.
Minor cervical cell changes known as LSIL are nearly always positive for
the high-risk types of HPV, so testing for HPV is not helpful. If you have
cervical cell changes classified as LSIL, colposcopy is often
If you are a teen and have had an ASC-US or LSIL Pap,
your doctor will likely recommend follow-up Pap tests instead of an HPV
If you need more information, see the topic
Abnormal Pap Test.