Cervical cell changes

Cervical cancer and precancerous lesions cause cell changes which can be detected with a gynecological smear test (Pap-test). If your Pap-test result is abnormal, you will receive an invitation to further examinations that typically include colposcopy and biopsy, which are performed even when cancer is not suspected. If the changes are mild, they are monitored with follow-up Pap-tests and sometimes also a HPV test.

The majority of cervical cell changes are caused by HPV (human papilloma virus) infection. There are 40 different types of papilloma viruses and 14 of those are oncogenic. On rare occasions, cellular changes may develop into cervical cancer via precancers over a period of several years. 

Studies show that three out of four people will be infected by HPV at some point during their lives. HPV is mainly transmitted sexually. Other routes of infection are possible but rare. The time of infection is often impossible to determine because there are no symptoms and the cell changes may occur years after the infection. In most cases, cell changes do not develop during a transient HPV infection. There is no drug treatment against HPV infection and your immune system can usually destroy the HPV viruses. Currently, HPV vaccinations are available to prevent infection. However, if you are already infected with HPV, the vaccination cannot resolve the infection. HPV infection is not the only cause of cervical cell changes.

When cervical cell changes have been detected, treatment depends on the findings. Moderate and severe precancers (CIN 2 and CIN 3) are treated while milder changes are merely monitored because they are very likely to resolve spontaneously. Half of the HPV infections causing cell changes pass in less than a year, and 90% in two to three years. In treatment abnormal cells and tissue are removed under local anesthesia using a loop and electric current (LEEP therapy). This is typically an outpatient procedure. Patients do not need to take sick leave after the treatment. However, you should avoid bathing, swimming, the use of tampons and sexual intercourse for three weeks after the procedure to reduce the risk of infection.

HPV can remain latent in the skin or mucosa and become active later.
Therefore, follow-up is essential. You will need to visit the outpatient clinic regularly for a time, but later participating in the national screening program is sufficient.

Using a condom is not necessary in a monogamous long-term relationship because both partners usually have or have had the virus (or antibodies). Wearing a condom when not in a long-term, mutually monogamous relationship reduces the risk of infection but does not offer 100% protection. Tobacco smoking increases the risk of cervical cancer development by three fold.  Cessation of smoking increases the chances of spontaneous resolving of the HPV-infection.