The Cervix

The cervix is the lower part of the uterus that connects the uterine cavity to the vagina. It is made up of different types of cells:

  • Squamous cells, which cover the outer surface of the cervix.
  • Glandular (columnar) cells, which line the cervical canal (endocervix) and produce mucus.

The area where these two cell types meet is called the transformation zone. This is where most precancerous lesions and cervical cancers develop.

Almost all cervical cancers are caused by persistent infection with certain types of high-risk Human Papillomavirus (HPV).

What Is Cervical Screening?

Cervical screening helps detect persistent HPV infections and precancerous changes before they develop into cancer. Thanks to cervical screening and HPV vaccination, cervical cancer is now largely preventable.

Current recommendations differ from those used in the past. Modern cervical screening is no longer based solely on cervical cytology (smear testing) and now incorporates high-risk HPV testing as the primary screening test for much of the eligible population.

Cervical Screening Programme in Spain

According to the latest National Health System recommendations:

Women Aged 25 to 29 Years

  • Women who have not received adequate HPV vaccination: cervical cytology every 3 years.

Women Aged 30 to 65 Years

  • Primary high-risk HPV testing every 5 years, regardless of vaccination status.

If the HPV test is positive, additional investigations are usually performed, including cervical cytology and, if required, colposcopy.

Who Should Participate in Screening?

Screening is recommended for people with a cervix who fall within the age groups included in national screening programmes, even if they:

  • Have no symptoms.
  • Have been vaccinated against HPV.
  • Are not currently sexually active.

Vaccination significantly reduces the risk of cervical cancer, but it does not protect against all cancer-causing HPV types. Screening therefore remains important.

Preparing for the Test

Cervical screening is a simple procedure that usually takes only a few minutes.

During the examination:

  1. A speculum is gently inserted into the vagina so that the cervix can be seen.
  2. A small brush is used to collect a sample of cells.
  3. The sample is sent to a laboratory for analysis.

To improve the quality of the sample, it is usually recommended that you:

  • Do not attend for screening during your menstrual period.
  • Inform the healthcare professional if you are pregnant.
  • Follow any specific instructions provided by your healthcare team.

Although some people may experience mild discomfort, the test is not usually painful.

Screening Results

Negative Result

A negative result means that no significant abnormalities or high-risk HPV infection have been detected based on the test performed. You will continue with routine screening at the recommended interval.

Positive HPV Result

A positive HPV result does not mean that you have cancer.

Most HPV infections clear naturally as a result of the body's immune response. However, infections that persist for many years may cause cellular changes that increase the risk of cancer.

Cellular Abnormalities

If abnormal cells are detected, additional tests may be needed to determine their clinical significance and whether follow-up or treatment is required.

Precancerous Cervical Lesions

International guidelines now generally use the histological classification of cervical squamous intraepithelial lesions:

Low-Grade Squamous Intraepithelial Lesion (LSIL)

LSIL usually corresponds to mild cellular changes associated with HPV infection and often resolves spontaneously.

High-Grade Squamous Intraepithelial Lesion (HSIL)

HSIL carries a higher risk of progression to cervical cancer if left untreated and usually requires specialist assessment and treatment.

CIN Terminology

Although still used in pathology reports, the CIN classification is generally integrated with the LSIL/HSIL system:

  • CIN 1: Low-grade lesion.
  • CIN 2: High-grade lesion.
  • CIN 3: High-grade lesion involving a larger proportion of the cervical epithelium.

These are precancerous lesions and are not the same as cancer. However, some may progress if they are not appropriately monitored or treated.

Diagnosis: Colposcopy

Colposcopy is the examination used to assess the cervix in more detail when abnormal screening results are found.

During the procedure:

  • A vaginal speculum is inserted.
  • Special solutions are applied to help identify abnormal areas.
  • The clinician examines the cervix using a colposcope, which remains outside the body.
  • If necessary, biopsies are taken for laboratory analysis.

The examination usually takes between 10 and 20 minutes. Most women report only mild and temporary discomfort.

Treatment of Precancerous Cervical Lesions

Not all cervical lesions require immediate treatment.

Low-grade lesions are often managed through monitoring, as many regress spontaneously.

When a high-grade lesion is present, treatment is generally recommended to prevent progression to cervical cancer.

Loop Electrosurgical Excision Procedure (LEEP/LLETZ)

This is currently one of the most commonly used treatments.

  • Usually performed under local anaesthesia.
  • Allows removal of the abnormal area of the cervix.
  • Is typically a short outpatient procedure.

Cervical Conisation

This procedure involves removing a cone-shaped section of tissue from the cervix.

It may be performed to:

  • Confirm the diagnosis.
  • Completely remove the lesion.
  • Treat certain high-grade lesions.

Other Treatments

In selected situations, other treatments may be used, including:

  • Ablative treatments.
  • Laser therapy.
  • Cryotherapy.

Hysterectomy is not part of the routine treatment of precancerous cervical lesions and is considered only in very specific circumstances.

Preventing Cervical Cancer

Current prevention strategies include:

  • HPV vaccination in accordance with national immunisation schedules.
  • Participation in organised cervical screening programmes.
  • Stopping smoking, as tobacco use increases the persistence of HPV infection and the risk of cervical abnormalities.
  • Seeking medical advice if symptoms occur, such as bleeding after sexual intercourse, bleeding between periods or persistent abnormal vaginal discharge.