Cervical cancer screening, which includes the Papanicolaou (Pap) test and human papillomavirus (HPV) testing, is a standard component of preventative healthcare. These tests identify abnormal cell changes early, long before cancer develops. For individuals who are pregnant, screening is often recommended as part of routine prenatal care. The timing of the test is usually addressed during the initial prenatal visits, ensuring the patient’s cervical health history is reviewed.
Cervical Cancer Screening During Pregnancy
The Pap test and HPV test are considered safe for both the mother and the developing fetus, and are routinely performed when a patient is due or overdue for screening. Healthcare providers typically review the patient’s screening history at the first prenatal appointment and proceed with the test if indicated. The procedure is designed to be minimally invasive, collecting only a sample of surface cells from the cervix.
During the procedure, the healthcare provider uses a specialized sampling device, such as a cyto-broom, designed to minimize the risk of bleeding. The test does not reach the uterus or the developing baby. Studies have not linked the screening procedure itself to an increased risk of miscarriage or other complications.
The physiological changes of pregnancy, such as increased blood flow to the cervix, can sometimes cause minor spotting after the test, but this is a temporary and benign side effect. If the screening test reveals an abnormality, it does not immediately mean cancer is present, but it does initiate a protocol for further, more detailed evaluation.
Diagnostic Steps After Abnormal Results
If a Pap or HPV test returns an abnormal result, the next step is usually a colposcopy, a procedure that allows for a magnified, visual examination of the cervix. This examination is also considered safe to perform during pregnancy and is typically conducted by a specialist to look for any high-grade lesions or signs of invasive cancer. During the colposcopy, a mild solution is applied to the cervix, which helps highlight any areas of abnormal tissue for closer inspection.
If suspicious areas are identified, a small tissue sample, or biopsy, may be taken to determine the exact nature of the cells. Clinicians typically avoid sampling tissue from the inner cervical canal during pregnancy to minimize the risk of complications, focusing only on the outer surface. For low-grade abnormalities, such as mild precancerous changes, the approach is usually one of close monitoring rather than immediate treatment.
This monitoring involves serial colposcopies throughout the pregnancy because many low-grade cervical changes spontaneously regress after delivery. Postponing definitive treatment for low-grade changes prioritizes fetal development and avoids unnecessary procedures. If the biopsy suggests a high-grade lesion or an invasive cancer is suspected, further, more urgent steps must be taken.
Treatment Strategies for Confirmed Cancer
A confirmed diagnosis of invasive cervical cancer during pregnancy requires balancing the mother’s need for treatment with the goal of fetal health. Treatment decisions depend on two main factors: the stage of the cancer and the gestational age of the fetus at the time of diagnosis. A multidisciplinary team, including a gynecologic oncologist and a maternal-fetal medicine specialist, guides this decision-making process.
For early-stage cancer, particularly if diagnosed in the second or third trimester, treatment may be delayed until the fetus reaches near-term (around 32 to 37 weeks of gestation). This delay allows for continued fetal growth while the patient is closely monitored for disease progression. In some cases, a procedure such as a cold knife conization may be performed in the second trimester to remove the cancerous tissue while preserving the pregnancy.
If the cancer is more advanced, or if the diagnosis is made early in the pregnancy, immediate treatment may be necessary, which can involve chemotherapy. Chemotherapy is generally avoided in the first trimester due to the risk of birth defects, but certain regimens can be administered safely during the second and third trimesters. When immediate treatment is unavoidable, the patient may need to consider an early delivery via Cesarean section so that aggressive therapies like radiation or surgery can begin immediately postpartum.