Cervical screening#Visual inspection to detect pre-cancer or cancer

File:Taking pap-smear 1.png

File:Journal.pone.0026395.g001 cervical cytology brushes.png

The procedures for testing women using Pap smear, liquid-based cytology, or HPV testing are similar. A sample of cells is collected from the cervix using a spatula or small brush. The cells are then checked for any abnormalities.{{Cite web |date=2011-02-23 |title=Pap Test |url=https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/pap-test |access-date=2021-09-20 |website=Cancer.Net |language=en}}

To take the sample of cells, the health care clinician inserts an instrument, called a speculum, inside the vagina. The speculum has two arms that spread the walls of the vagina apart in order to see the cervix. Then, they scrape the surface of the cervix with a spatula or small brush. This collects a sample of cells from the outer layer of the cervix.

Self-collection is also an option when testing by a provider is unavailable or uncomfortable for a patient. When utilizing HPV testing, self-collection has been shown to be as accurate as swabbing by a provider. This equality has not been demonstrated for other testing such as pap smear or liquid-based cytology.

With a Pap smear, cells collected using a spatula are smeared onto a slide for examination under a microscope. In liquid-based cytology, a sample of cells is taken using a small brush. The cells are put into a container of liquid, and analysed for abnormalities. Cervical cells to be tested for HPV are collected in a similar way.{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/cervical-cancer-screening-tests-techniques-for-cervical-cytology-and-human-papillomavirus-testing |access-date=2021-09-20 |website=www.uptodate.com}}

Molecular testing identifies an infection called human papillomavirus, or HPV. Human papillomavirus (HPV) infection is a cause of nearly all cases of cervical cancer.{{cite journal |display-authors=6 |vauthors=Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, Snijders PJ, Peto J, Meijer CJ, Muñoz N |date=September 1999 |title=Human papillomavirus is a necessary cause of invasive cervical cancer worldwide |journal=The Journal of Pathology |volume=189 |issue=1 |pages=12–9 |doi=10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F |pmid=10451482 |s2cid=1522249}} Most women will successfully clear HPV infections within 18 months. Those that have a prolonged infection with a high-risk type (e.g. types 16, 18, 31, 45) are more likely to develop Cervical Intraepithelial Neoplasia, due to the effects that HPV has on DNA.{{cite journal |vauthors=Cuschieri KS, Cubie HA, Whitley MW, Gilkison G, Arends MJ, Graham C, McGoogan E |date=September 2005 |title=Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study |journal=Journal of Clinical Pathology |volume=58 |issue=9 |pages=946–50 |doi=10.1136/jcp.2004.022863 |pmc=1770812 |pmid=16126875}}

The screening process utilizes nucleic acid amplification testing to look for DNA or RNA of the virus present within cervical cells. Some tests can identify up to 14 different types of high risk strains.

Accuracy of HPV testing report:

• sensitivity 88% to 91% (for detecting CIN 3 or higher){{cite journal |vauthors=Kulasingam SL, Hughes JP, Kiviat NB, Mao C, Weiss NS, Kuypers JM, Koutsky LA |date=October 2002 |title=Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral |journal=JAMA |volume=288 |issue=14 |pages=1749–57 |doi=10.1001/jama.288.14.1749 |pmid=12365959 |doi-access=}} to 97% (for detecting CIN2+){{cite journal |display-authors=6 |vauthors=Cuzick J, Szarewski A, Cubie H, Hulman G, Kitchener H, Luesley D, McGoogan E, Menon U, Terry G, Edwards R, Brooks C, Desai M, Gie C, Ho L, Jacobs I, Pickles C, Sasieni P |date=December 2003 |title=Management of women who test positive for high-risk types of human papillomavirus: the HART study |journal=Lancet |volume=362 |issue=9399 |pages=1871–6 |doi=10.1016/S0140-6736(03)14955-0 |pmid=14667741 |s2cid=26008721}}
• specificity 73% to 79% (for detecting CIN 3 or higher) to 93% (for detecting CIN2+)

{{Main|Pap test}}

File:Normal PAP (Cervical) Smear.jpg

In the conventional Pap smear, the collected cells are smeared on a microscope slide, and a fixative is applied. The slide is evaluated in a pathology lab to identify cellular abnormalities.

Accuracy of conventional cytology report:{{cite journal | last1=Arbyn | first1=Marc | last2=Bergeron | first2=Christine | last3=Klinkhamer | first3=Paul | last4=Martin-Hirsch | first4=Pierre | last5=Siebers | first5=Albertus G. | last6=Bulten | first6=Johan | title=Liquid Compared With Conventional Cervical Cytology | journal=Obstetrics & Gynecology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=111 | issue=1 | year=2008 | issn=0029-7844 | doi=10.1097/01.aog.0000296488.85807.b3 | pages=167–177| pmid=18165406 | s2cid=4918809 }}

• sensitivity: 55% to 88%
• specificity: 71% to 94%

{{Main|Liquid-based cytology|l1=Liquid based cytology}}

In liquid based monolayer cytology, the collected cells are placed into a liquid medium. The sample is evaluated in a pathology lab to evaluate cellular abnormalities.

Accuracy of liquid based monolayer cytology report:

• sensitivity 57% to 90%
• specificity 64% to 97%

Visual inspection involves the application of ascetic acid or lugol's iodine solution to the cervix. These solutions highlight abnormal areas for easier identification with the naked eye. Visual inspection can include receiving a colposcopy if results from cytologic screenings produce abnormal results.{{Cite web |title=Colposcopy |url=https://www.nhsinform.scot/tests-and-treatments/non-surgical-procedures/colposcopy/#:~:text=Although%20abnormal%20cervical%20screening%20results,and%20how%20advanced%20they%20are. |access-date=2025-04-03 |website=NHS inform |language=en-GB}} A magnifying camera called a colposcope can also be utilized for clearer viewing when available. Through visual inspection, abnormalities can be detected within the cervix. If detected, abnormal tissue can then be sampled and taken for further testing.{{Cite journal |last=Szarewski |first=Anne |date=2007-08-04 |title=Cervical screening by visual inspection with acetic acid |url=https://pubmed.ncbi.nlm.nih.gov/17678998 |journal=Lancet |volume=370 |issue=9585 |pages=365–366 |doi=10.1016/S0140-6736(07)61171-4 |issn=1474-547X |pmid=17678998}}

Combination testing or co-testing, is when individuals receive both molecular high risk HPV testing and cytology.{{Cite web |title=Updated Cervical Cancer Screening Guidelines |url=https://www.acog.org/en/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines |access-date=2022-09-14 |website=www.acog.org |language=en}} These results can be utilized to calculate the patient's immediate risk for cervical intraepithelial neoplasia grade 3 or cancer (CIN3+).{{Cite journal |last1=Perkins |first1=Rebecca B. |last2=Guido |first2=Richard S. |last3=Castle |first3=Philip E. |last4=Chelmow |first4=David |last5=Einstein |first5=Mark H. |last6=Garcia |first6=Francisco |last7=Huh |first7=Warner K. |last8=Kim |first8=Jane J. |last9=Moscicki |first9=Anna-Barbara |last10=Nayar |first10=Ritu |last11=Saraiya |first11=Mona |last12=Sawaya |first12=George F. |last13=Wentzensen |first13=Nicolas |last14=Schiffman |first14=Mark |last15=Committee |first15=for the 2019 ASCCP Risk-Based Management Consensus Guidelines |date=April 2020 |title=2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors |journal=Journal of Lower Genital Tract Disease |language=en-US |volume=24 |issue=2 |pages=102–131 |doi=10.1097/LGT.0000000000000525 |issn=1526-0976 |pmc=7147428 |pmid=32243307}}

The calculated risk can be used to recommend appropriate follow-up options.{{citation needed|date=March 2023}}

Cervical screening demographics are largely measured by motives or reasons for participation and thus vary between age, socio-economic status, race, location, and ethnicity. In practice, cervical screenings are often undergone to test for cervical cancer, but are dually used to test for other conditions such as STIs, inflammation, and precancerous cells.

Cervical screenings typically begin at ages 21–25, with the recommended age being 21. Testing for cervical cancer should occur at least every 3 years, and HPV every 5 years. However, if test results are abnormal, healthcare providers may suggest more frequent screenings.{{Cite web |date=2025-04-18 |title=Cervical Cancer Screening (PDQ®) - NCI |url=https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq |access-date=2025-04-24 |website=www.cancer.gov |language=en}} If patients are sexually active, recommendations for screenings may change or vary as increased sexual activity is a strong risk factor for developing HPV.

Cervical cancer has a distinct disparity in diagnosis associated with access to care, specifically access to cervical screening.{{Cite journal |last1=Musselwhite |first1=Laura W. |last2=Oliveira |first2=Cristina M. |last3=Kwaramba |first3=Tendai |last4=de Paula Pantano |first4=Naitielle |last5=Smith |first5=Jennifer S. |last6=Fregnani |first6=José Humberto |last7=Reis |first7=Rui M. |last8=Mauad |first8=Edmundo |last9=Vazquez |first9=Fabiana de Lima |last10=Longatto-Filho |first10=Adhemar |date=2016 |title=Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes |url=https://pubmed.ncbi.nlm.nih.gov/27825171 |journal=Acta Cytologica |volume=60 |issue=6 |pages=518–526 |doi=10.1159/000452240 |issn=1938-2650 |pmid=27825171}} This disparity is reflected in higher rates of cervical cancer found among minority groups in countries with higher economic status, as well as higher rates of cervical cancer found in lower-income global areas in comparison to advantaged groups. Globally, cervical cancer is most prominent in developing countries, with 80% of cases globally occurring within lower socio-economic countries.{{Cite journal |last1=Hull |first1=Rodney |last2=Mbele |first2=Mzwandile |last3=Makhafola |first3=Tshepiso |last4=Hicks |first4=Chindo |last5=Wang |first5=Shao-Ming |last6=Reis |first6=Rui Manuel |last7=Mehrotra |first7=Ravi |last8=Mkhize-Kwitshana |first8=Zilungile |last9=Kibiki |first9=Gibson |last10=Bates |first10=David O. |last11=Dlamini |first11=Zodwa |date=September 2020 |title=Cervical cancer in low and middle-income countries |journal=Oncology Letters |volume=20 |issue=3 |pages=2058–2074 |doi=10.3892/ol.2020.11754 |issn=1792-1074 |pmc=7400218 |pmid=32782524}} Within the US, there is a significant disparity in rates of cervical cancer diagnosis among black women compared to white women, with mortality rates of black women with cervical cancer being severely underestimated.{{Cite journal |last1=Beavis |first1=Anna L. |last2=Gravitt |first2=Patti E. |last3=Rositch |first3=Anne F. |date=2017-05-15 |title=Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States |url=https://pubmed.ncbi.nlm.nih.gov/28112816 |journal=Cancer |volume=123 |issue=6 |pages=1044–1050 |doi=10.1002/cncr.30507 |issn=1097-0142 |pmid=28112816}} In light of such disparities, appropriate screening and greater efforts towards intervention are highly recommended.

Different countries and medical organizations have specific cervical screening recommendations to guide patient care.

In 2021 the World Health Organization published the second edition of WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. Within this publication they outline 23 recommendations addressing differences in guidelines for women living with or without HIV. The quality of evidence is rated strong, moderate, low or very low. Some of the recommendations are included below, this is not a comprehensive list.

• HPV molecular testing recommended as primary screening, with or without triage, in all women. HPV screening should occur every 5 to 10 years.
• When used, VIA or cytologic screening should occur every 3 years.
• Begin screening at the age of 30
• Stop screening at the age of 50, as long as most recent two tests were negative

Most countries suggest or offer screening between the ages of 25 and 64.{{cite web |title=Everything about cervical cancer prevention |url=http://www.ecca.info/ |access-date=2015-05-09 |website=www.ecca.info |archive-date=2015-05-09 |archive-url=https://web.archive.org/web/20150509232412/http://www.ecca.info/ |url-status=dead }} According to the 2015 European guidelines for cervical cancer screening, routine HPV primary screening should not begin under 30 years of age. Primary testing for oncogenic HPV can be used in a population-based program for cervical cancer screening.{{Cite journal |display-authors=6 |vauthors=von Karsa L, Arbyn M, De Vuyst H, Dillner J, Dillner L, Franceschi S, Patnick J, Ronco G, Segnan N, Suonio E, Törnberg S, Anttila A |date=2015-12-01 |title=European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination |journal=Papillomavirus Research |language=en |volume=1 |pages=22–31 |doi=10.1016/j.pvr.2015.06.006 |pmc=5886856}} In England, the NHS cervical screening program is available to women aged 25 to 64; women aged 25 to 49 receive an invitation every 3 years and women aged 50 to 64 receive an invitation every 5 years to undergo HPV testing.{{Cite web |date=2019-02-27 |title=Cervical screening results - NHS |url=https://www.nhs.uk/conditions/cervical-screening/your-results/ |access-date=2022-09-14 |website=nhs.uk |language=en}}{{cite web |title=Cervical screening: programme overview |url=https://www.gov.uk/guidance/cervical-screening-programme-overview |website=GOV.UK |date=17 March 2021 |publisher=Public Health England}} If there is a positive HPV test result, then patients undergo further cytology (Pap smear).

In the US, doctors follow the guidelines of both the American College of obstetrics and Gynecology (ACOG) or the United States Preventative Services Task Force (USPSTF) for cervical cancer screening, which are primarily stratified by age.{{Cite web |title=Draft Recommendation: Cervical Cancer: Screening {{!}} United States Preventive Services Taskforce |url=https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/cervical-cancer-screening-adults-adolescents |access-date=2025-02-17 |website=www.uspreventiveservicestaskforce.org}} Screening is recommended for women between ages 21 and 65 every 3 years using cervical cytology, regardless of age at sexual initiation or other high-risk behaviors.{{cite web |title=SEER Stat Fact Sheets: Cervix Uteri Cancer |url=http://seer.cancer.gov/statfacts/html/cervix.html |access-date=8 April 2014}}{{cite journal |vauthors=Karjane N, Chelmow D |date=June 2013 |title=New cervical cancer screening guidelines, again |journal=Obstetrics and Gynecology Clinics of North America |volume=40 |issue=2 |pages=211–23 |doi=10.1016/j.ogc.2013.03.001 |pmid=23732026}}{{cite web |author=Center for Disease Control |title=Cervical Cancer Screening Guidelines for Average-Risk Women |url=https://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf |access-date=17 April 2014}}

The age-based recommendations by both institutions are as follows:

• No screening recommended for women less than 21.
• From ages 21 to 29, a pap smear is recommended every three years with cervical cytology alone.
• From ages 30 to 65, women can choose between a pap smear every three year or an FDA-approved primary high risk HPV test every five years, or pap smear and HPV co-testing every five years.
• In women over the age of 65, screening for cervical cancer may be discontinued in the absence of abnormal screening results within the prior 10 years and no history of high-grade lesions.
• For women with other comorbidities these guidelines may differ.

In addition to the age-based guidelines provided by the USPSTF and ACOG, are risk-based guidelines established by a consensus of medical professionals (i.e. the American Academy of Family Physicians, the American Cancer Society, ACOG, etc.), government organizations (i.e. the National Cancer Institute), and patient advocacy groups. These risk-based guidelines take into account an individuals current and prior cervical screening results in order to estimate an individuals immediate and 5-year risk of developing CIN 3 or higher. The risk estimates are then used by practitioners to help determine screening and surveillance intervals, as well as management of results (i.e. further evaluation with colposcopy or treatment). Based on an individuals risk estimates, the practitioner may recommend the individual continue with age-based screening recommendations or return for surveillance at shorter intervals (i.e. 1 year or 4 months). Alternatively, an individuals risk estimate may warrant the recommendation of colposcopy with biopsy for further evaluation or expedited treatment.{{Cite journal |last1=Perkins |first1=Rebecca B. |last2=Guido |first2=Richard S. |last3=Castle |first3=Philip E. |last4=Chelmow |first4=David |last5=Einstein |first5=Mark H. |last6=Garcia |first6=Francisco |last7=Huh |first7=Warner K. |last8=Kim |first8=Jane J. |last9=Moscicki |first9=Anna-Barbara |last10=Nayar |first10=Ritu |last11=Saraiya |first11=Mona |last12=Sawaya |first12=George F. |last13=Wentzensen |first13=Nicolas |last14=Schiffman |first14=Mark |last15=2019 ASCCP Risk-Based Management Consensus Guidelines Committee |date=2020 |title=2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors |journal=Journal of Lower Genital Tract Disease |volume=24 |issue=2 |pages=102–131 |doi=10.1097/LGT.0000000000000525 |issn=1526-0976 |pmc=7147428 |pmid=32243307}}{{Cite journal |last1=Perkins |first1=Rebecca B. |last2=Guido |first2=Richard S. |last3=Castle |first3=Philip E. |last4=Chelmow |first4=David |last5=Einstein |first5=Mark H. |last6=Garcia |first6=Francisco |last7=Huh |first7=Warner K. |last8=Kim |first8=Jane J. |last9=Moscicki |first9=Anna-Barbara |last10=Nayar |first10=Ritu |last11=Saraiya |first11=Mona |last12=Sawaya |first12=George F. |last13=Wentzensen |first13=Nicolas |last14=Schiffman |first14=Mark |last15=2019 ASCCP Risk-Based Management Consensus Guidelines Committee |date=2024-01-01 |title=2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023 |journal=Journal of Lower Genital Tract Disease |volume=28 |issue=1 |pages=3–6 |doi=10.1097/LGT.0000000000000788 |issn=1526-0976 |pmc=10755815 |pmid=38117563}}{{Cite journal |last1=Egemen |first1=Didem |last2=Cheung |first2=Li C. |last3=Chen |first3=Xiaojian |last4=Demarco |first4=Maria |last5=Perkins |first5=Rebecca B. |last6=Kinney |first6=Walter |last7=Poitras |first7=Nancy |last8=Befano |first8=Brian |last9=Locke |first9=Alexander |last10=Guido |first10=Richard S. |last11=Wiser |first11=Amy L. |last12=Gage |first12=Julia C. |last13=Katki |first13=Hormuzd A. |last14=Wentzensen |first14=Nicolas |last15=Castle |first15=Philip E. |date=2020 |title=Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines |journal=Journal of Lower Genital Tract Disease |volume=24 |issue=2 |pages=132–143 |doi=10.1097/LGT.0000000000000529 |issn=1526-0976 |pmc=7147417 |pmid=32243308}}

In the UK, guidelines administered by the National Health Service of England (NHS England) recommend and offer cervical screening to women ages 25–64.{{Cite web |date=2025-04-16 |title=Cervical screening: programme overview |url=https://www.gov.uk/guidance/cervical-screening-programme-overview |access-date=2025-04-25 |website=GOV.UK |language=en}} Invitations to receive cervical screening are administered via mail to all individuals registered within a General Practice, with initial invitations sent to those aged 24–25. Invitations are sent every 3 years. Cervical screenings primarily look for the presence of human papillomavirus (HPS), specifically looking at the presence of abnormal cells within the cervix. If abnormal cells are reported, patients will receive a colposcopy, and further testing and treatment will be administered if necessary. If the test yields no abnormal results, routine screening will be offered every 3–5 years, depending on age and sexual activity.

In the greater Americas, specifically Latin America, cervical screening guidelines are administered by the Pan American Health Organization (PAHO) and the World Health Organization (WHO). As a result, screening guidelines are similar to that of the US. However, guidelines vary by country. Current guidelines in Mexico suggest screening to be administered to those aged 25–64, however, it can begin earlier if individuals have engaged in sexual activity before the age of 25.{{Cite journal |last=Fernández-Deaza |first=Ginna |last2=Caicedo-Martínez |first2=Maria |last3=Serrano |first3=Beatriz |last4=Roura |first4=Esther |last5=Castillo |first5=Juan Sebastián |last6=De Sanjosé |first6=Silvia |last7=Bruni |first7=Laia |last8=Murillo |first8=Raúl |date=2022-07-08 |title=Cervical cancer screening programs in Latin America: current recommendations for facing elimination challenges |url=https://pubmed.ncbi.nlm.nih.gov/36130384 |journal=Salud Publica De Mexico |volume=64 |issue=4, jul-ago |pages=415–423 |doi=10.21149/13204 |issn=1606-7916 |pmid=36130384|doi-access=free |hdl=2445/192292 |hdl-access=free }} The testing routine calls for screenings at least every 5–10 years following the initial screening.{{Cite web |title=Latin America and the Caribbean Code against Cancer - PAHO/WHO {{!}} Pan American Health Organization |url=https://www.paho.org/en/latin-america-and-caribbean-code-against-cancer#:~:text=every%20two%20years.-,Based%20on%20the%20results,%20follow%20your%20health%20professional's%20recommendations%20promptly,early%20detection%20of%20cervical%20cancer. |access-date=2025-04-25 |website=www.paho.org |language=en}}

Screening is offered to women aged 18–70, every two years. This is by Pap smear, and regardless of sexual history.[http://www.cancer.org.au/preventing-cancer/early-detection/screening-programs/cervical-cancer-screening.html "Cervical cancer screening"], Cancer Council Australia, accessed 14 November 2015{{update inline|date=September 2021}} In Canada, where screening programs are arranged at provincial level, the general recommendation is not to begin routine screening until the age of 25 in the absence of specific reasons to, then to screen every three years until the age of 69.{{cite web |date=2013 |title=Screening for Cervical Cancer |url=http://canadiantaskforce.ca/ctfphc-guidelines/2013-cervical-cancer/ |archive-url=https://web.archive.org/web/20151117025337/http://canadiantaskforce.ca/ctfphc-guidelines/2013-cervical-cancer/ |archive-date=2015-11-17 |access-date=14 November 2015 |work=Canadian Task Force for Preventive Health Care}} In Ontario, "The Ontario Cervical Screening Program recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21."{{cite web |title=Cervical Cancer Screening |url=https://www.cancercare.on.ca/pcs/screening/cervscreening/ |access-date=14 November 2015 |work=Cancer Care Ontario}}

The Ministry of Public Health recommends women from age 30-60 receive primary HPV testing every 5 years. Based on the results of the test, those with higher risk strains of HPV will be referred for colposcopy, while those with lower risk strains will be referred for cytology.{{Cite journal |last1=Aoki |first1=Eiko Saitoh |last2=Yin |first2=Rutie |last3=Li |first3=Kemin |last4=Bhatla |first4=Neerja |last5=Singhal |first5=Seema |last6=Ocviyanti |first6=Dwiana |last7=Saika |first7=Kumiko |last8=Suh |first8=Mina |last9=Kim |first9=Miseon |last10=Termrungruanglert |first10=Wichai |date=2020-02-26 |title=National screening programs for cervical cancer in Asian countries |journal=Journal of Gynecologic Oncology |volume=31 |issue=3 |pages=e55 |doi=10.3802/jgo.2020.31.e55 |issn=2005-0380 |pmc=7189071 |pmid=32266804}}

Screening results are generally categorized as normal or abnormal. Women who receive an abnormal test result will be guided on their next recommended steps by their healthcare provider. Management is significantly impacted based on the type of testing done, and the severity of the abnormality. Some of the follow-up options include surveillance, histological diagnosis via colposcopy/biopsy, or removal of the abnormal tissue via an ablative or surgical method.

The World Health Organization outlines two different approaches to cervical screening and follow-up. They are the Screen and Treat; and the Screen, Triage and Treat. Patient preferences, healthcare access and system resources are factors that play a role in which approach providers will recommend to their patients.

Laser ablation and cryotherapy treat just the part of the cervix that contains abnormal cells. Laser ablation uses a laser to burn away the abnormal cells, while cryotherapy uses a cold probe to freeze the cells away. These procedures allow normal cells to grow back in their place. The loop electrical excision procedure (called LLETZ or 'large loop excision of the transformation zone' in the UK), cervical conization (or cone biopsy) and hysterectomy remove the whole area containing the abnormal cells.{{Cite journal |last1=Apgar |first1=Barbara S. |last2=Kaufman |first2=Amanda J. |last3=Bettcher |first3=Catherine |last4=Parker-Featherstone |first4=Ebony |date=2013-06-15 |title=Gynecologic procedures: colposcopy, treatments for cervical intraepithelial neoplasia and endometrial assessment |url=https://pubmed.ncbi.nlm.nih.gov/23939565 |journal=American Family Physician |volume=87 |issue=12 |pages=836–843 |issn=1532-0650 |pmid=23939565}}

The Bill and Melinda Gates Foundation has funded an eight-year study of a DNA test for the virus that causes cervical cancer. The test manufactured by Qiagen for a low cost per test with results available in only a few hours may allow reduction in use of annual Pap smears. The test has been shown to work "acceptably well" on women who take the swabs themselves rather than allowing a physician to test. This may improve the chances of early diagnosis for women who are unwilling to be screened due to discomfort or modesty.{{cite news| url=https://www.nytimes.com/2009/04/07/health/07virus.html | work=The New York Times | title=DNA Test Outperforms Pap Smear | vauthors = McNeil Jr DG | date=2009-04-07 | access-date=2010-05-21}}

VIA, one of the alternative approaches to conventional testing, has shown to have a low specificity compared to cytology and a high rate of false positives in several studies.{{cite journal | vauthors = Jeronimo J, Bansil P, Lim J, Peck R, Paul P, Amador JJ, Mirembe F, Byamugisha J, Poli UR, Satyanarayana L, Asthana S | display-authors = 6 | title = A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer | journal = International Journal of Gynecological Cancer | volume = 24 | issue = 3 | pages = 576–85 | date = March 2014 | pmid = 24557438 | pmc = 4047307 | doi = 10.1097/igc.0000000000000084 }}{{cite journal | vauthors = Longatto-Filho A, Naud P, Derchain SF, Roteli-Martins C, Tatti S, Hammes LS, Sarian LO, Eržen M, Branca M, de Matos JC, Gontijo R, Maeda MY, Lima T, Costa S, Syrjänen S, Syrjänen K | display-authors = 6 | title = Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology | journal = Virchows Archiv | volume = 460 | issue = 6 | pages = 577–85 | date = June 2012 | pmid = 22562132 | doi = 10.1007/s00428-012-1242-y | s2cid = 20361024 }}{{cite journal | vauthors = Labani S, Asthana S, Sodhani P, Gupta S, Bhambhani S, Pooja B, Lim J, Jeronimo J | title = CareHPV cervical cancer screening demonstration in a rural population of north India | journal = European Journal of Obstetrics, Gynecology, and Reproductive Biology | volume = 176 | issue = | pages = 75–9 | date = May 2014 | pmid = 24685404 | doi = 10.1016/j.ejogrb.2014.03.006 }}{{cite journal | vauthors = Gravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KV | display-authors = 6 | title = Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India | journal = PLOS ONE | volume = 5 | issue = 10 | pages = e13711 | date = October 2010 | pmid = 21060889 | pmc = 2965656 | doi = 10.1371/journal.pone.0013711 | bibcode = 2010PLoSO...513711G | doi-access = free }} Entities such as inflammation, cervical condyloma and leukoplakia can give false positive results of VIA test.International Agency for Research on Cancer. A practical manual on visual screening for cervical neoplasia. Lyon, France: IARC; 2003. There is no permanent record of the test to be reviewed later. Between community centers high variability has been observed, and even in a study of Nigeria of 2013 VIA was not reproducible nor sensitive; this led to discouraging the method in that country.{{cite journal | vauthors = Ajenifuja KO, Gage JC, Adepiti AC, Wentzensen N, Eklund C, Reilly M, Hutchinson M, Burk RD, Schiffman M | display-authors = 6 | title = A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria | journal = International Journal of Gynecological Cancer | volume = 23 | issue = 3 | pages = 507–12 | date = March 2013 | pmid = 23354369 | pmc = 3580031 | doi = 10.1097/igc.0b013e318280f395 }}

In addition, p16/Ki-67 are emerging biomarkers that have been used as a triage method for HPV-positive patients. In studies conducted so far, p16/Ki-67 dual staining had a higher sensitivity and specificity compared to cytology. Using these biomarkers may help in reducing the number of false-positive tests and unnecessary examinations.{{cite journal | vauthors = Hamashima C | title = Emerging technologies for cervical cancer screening | journal = Japanese Journal of Clinical Oncology | volume = 51 | issue = 9 | pages = 1462–1470 | date = July 2021 | pmid = 34245284 | doi = 10.1093/jjco/hyab109 }}

Assessing DNA methylation patterns in individuals with HPV is also an emerging screening method. There are about 80 methylation patterns that can serve as potential biomarkers for cervical cancer. Molecular testing of DNA methylation patterns is more objective than cytology testing and can be automated, requiring less training with more precision.

Vaginal and urine self-sampling have shown promising results in detecting the signs of cervical cancer. They also offer a more environmentally friendly alternative to in-person screening.{{Cite journal |last1=Whittaker |first1=Maya |last2=Davies |first2=Jennifer C. |last3=Sargent |first3=Alexandra |last4=Sawyer |first4=Matt |last5=Crosbie |first5=Emma J. |date=1 April 2024 |title=A comparison of the carbon footprint of alternative sampling approaches for cervical screening in the UK : A descriptive study |journal=BJOG: An International Journal of Obstetrics & Gynaecology |language=en |volume=131 |issue=5 |pages=699–708 |doi=10.1111/1471-0528.17722 |issn=1470-0328|doi-access=free |pmid=38012840 }}{{Cite journal |date=22 August 2024 |title=Cervical screening: home self-sampling could be environmentally friendly |url=https://evidence.nihr.ac.uk/alert/cervical-screening-home-self-sampling-could-be-environmentally-friendly/ |journal=NIHR Evidence}}

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