Most of the time, cervical cell changes (abnormal cells) don’t come back after treatment. However, sometimes they do and may need further treatment. These cell changes are also called persistent or recurrent cell changes.
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Cell changes (abnormal cells) that come back
- Onuki M. et al, Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis, Journal of Gynaecological Oncology, 2016.
- Cancer Research UK, Cervical Cancer Risk, www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer/risk-factors Accessed: February 2019.
- International Collaboration of Epidemiological Studies of Cervical Cancer: Appleby P. et al, Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies, International Journal of Cancer, 2006.
- NHS Inform, Colposcopy - Tests & treatments www.nhsinform.scot/tests-and-treatments/non-surgical-procedures/colposcopy Accessed: June 2019.
Key facts about cell changes coming back
- Most cell changes do not come back after treatment.
- Sometimes cell changes may come back and need further treatment.
- Having cell changes that come back does not mean you will definitely develop cervical cancer.
- If you have cell changes that have come back, it is important to speak to your colposcopy team about any questions and preferences you have for treatment.
Why do cell changes (abnormal cells) come back?
After treatment for cell changes:
- about 9 in 10 (90%) people will not have cell changes again
- fewer than 2 in 10 (between 5% and 15%) people may have cell changes that come back.
Cell changes may come back if we have a virus called human papillomavirus (HPV) . It’s a common virus that most of us will get at some point in our lives. There are over 200 HPV types, including some that can cause cell changes in the cervix. We call these types high-risk HPV.
Usually, your immune system gets rid of HPV without it causing cell changes, but some people find HPV harder to clear. Sometimes, HPV can stay in the body and cause the cells of the cervix to change.
What happens if cell changes come back?
We know that cell changes coming back can be worrying or upsetting. It may help to try to remember:
- it does not mean you will develop cervical cancer
- they can be managed with monitoring or treatment.
Although it may be difficult to go through getting these results and the next steps again, it means your colposcopy team can make sure you get the right care and support.
Your follow up appointment
If cell changes come back, they are usually found after your follow-up appointment.
If your cervical screening (smear test) done during this appointment finds high-risk HPV, you will usually have further tests at colposcopy again.
Read more about follow-up after treatment for cell changes >
Further tests at colposcopy
The colposcopy appointment will be the same as your first one.
You will usually have another biopsy (sample of cervical tissue) taken. The result of the biopsy will help to decide what happens next:
- If you have low-grade cell changes (CIN1), you may not need treatment and may be invited for another follow-up appointment in 12 months.
- If you have high-grade cell changes (CIN2, CIN3 or CGIN), you may need further treatment.
As well as the biopsy result, your colposcopy team will look at other things when making a decision about next steps, including:
- your history of cell changes
- your age
- your general medical history and health.
Treatment for cell changes that have come back
Large loop excision of the transformation zone (LLETZ) is the most common treatment offered for cell changes that have come back. This treatment removes the affected area.
Side effects and possible risks of further treatment
Before offering you further treatment, your colposcopist will think about any possible risks of multiple treatments. They should discuss these with you, so you can be involved in making decisions about treatment.
If you have had treatment before, any risks are usually the same as they were after that treatment. However, if you have a treatment that removes some of the cervix such as LLETZ, there may be a slightly increased risk of giving birth early (premature birth), as more of your cervix will be removed .
Read more about risks of different treatments for cell changes >
Cell changes that keep coming back
If cell changes come back more than once, your colposcopy team with talk you through the different options. Usually, treatment will be offered again.
Hysterectomy for cell changes
In some cases, you may be offered a hysterectomy for cell changes that keep coming back. Your colposcopy team will only offer this if:
- they think there is a high risk the cell changes may develop into cervical cancer in future
- it is not possible to safely do another LLETZ, as you may experience impacts such as increased risk of future pre-term birth.
As with any treatment, your colposcopy team or a surgeon will talk through hysterectomy with you. When this happens, it is important that you can discuss things that are important to you, like whether you have had the number of children you want or been through menopause.
Some people choose to have a hysterectomy so they can be certain all the cell changes are gone. If you have a hysterectomy for this reason, you can usually keep your ovaries, so it should not affect your hormones or trigger an early menopause.
We have more information about hysterectomy, which you can read by clicking the link below. Please note that this page is written for those having a hysterectomy for cervical cancer, which may be worrying – but remember that cell changes are not cervical cancer.
Your feelings about cell changes coming back
You may feel a mix of emotions on hearing that cell changes have come back – from relief that they have been found and can to be treated, worry about the next steps, or upset that you have to go through this again . There is no right or wrong way to feel, but it is important that you are able to manage those emotions and get the right support.
Our tips for looking after yourself
- Acknowledge how you feel. Getting a result showing cell changes, especially if you have had them before, can be difficult. If you feel a mix of emotions, or confusion about what you’re feeling, give yourself space to try to figure it out and process that. You may prefer to do this by yourself or with a trusted loved one.
- Talk with your colposcopy team. They can help you understand the next steps, what the result means for your health and, if they know how you’re feeling, give you emotional support. Don’t be afraid to ask as many questions as you need.
- Speak with a trusted person. If you have family or friends to lean on, they may be able to offer emotional or practical support through the next steps – from listening to how you’re feeling, dropping off a care package, or arranging something nice after an appointment. If you don’t have family or friends, you can use our services to get support, including our Forum where you can chat with others who have been through a similar experience.
- Arrange a treat on appointment or results days. Going to appointments and waiting for, or getting, results can be tough for some people. It might help to have something nice planned afterwards, whether it’s on the same day or later in the week – it could be your favourite takeaway, a meet up or phone chat with a friend, or some time relaxing with a TV show or book.
- Remember that we are here for you. You might want to call our Helpline on 0808 802 8000 or join our forum to chat with those who’ve been through something similar.
Cell changes coming back FAQs
The most common reason for cell changes to come back would be your immune system not getting rid of high-risk HPV. We don’t yet know why some people can clear HPV and others can’t. But going for your follow up appointments helps your colposcopy team keep a close eye on HPV and any cell changes, so they can make sure you get the right care.
Having persistent HPV does not mean you will always have cell changes, or that they will keep coming back.
Sometimes, our immune system just has a harder time getting rid of HPV and there is not much we can do about it. But, for some people, there are lifestyle changes that may reduce the risk of cell changes coming back.
If you smoke, you may want to try to stop. Smoking makes your immune system weaker, which may mean:
- it is less likely to get rid of high-risk HPV
- cell changes infected with HPV are less likely to get better
- cell changes infected with HPV are more likely to progress to a higher grade.
Stopping smoking can be hard, especially if you are already struggling with cell changes or treatment. But if you want to stop, support is available:
- If you live in England, visit Smokefree >
- If you live in Scotland, visit Quit Your Way >
- If you live in Wales, visit Help Me Quit >
- If you live in Northern Ireland, visit Stop Smoking NI >
How we can help
We know that having cell changes come back can be confusing and sometimes worrying. Your colposcopy team will be able to help answer any questions, as they know your background and medical history.
We are also here to support you. Our Helpline volunteers all have personal or professional experience of cell changes or cervical cancer, so can empathise with what you’re going through – you can email us or call us on 0808 802 8000.
Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.
Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.
References
- Lili E. et al (2018). Low recurrence rate of high-grade cervical intraepithelial neoplasia after successful excision and routine colposcopy during follow-up. Medicine (Baltimore). 97;4.
- Swift B. et al (2020). Risk of Recurrence After Treatment for Cervical Intraepithelial Neoplasia 3 and Adenocarcinoma In Situ of the Cervix: Recurrence of CIN 3 and AIS of Cervix. Journal of Lower Genital Tract Disease. 24;3. pp.252-258.
- Onuki M. et al (2016). Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis. Journal of Gynaecological Oncology.
- Castanon A. et al (2014). Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. BMJ.
- International Collaboration of Epidemiological Studies of Cervical Cancer: Appleby P. et al (2006). Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies, International Journal of Cancer.
We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk
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Date last updated:
14 Jan 2022
Date due for review:
14 Jan 2025