One risk of the further screening for cervical cancer is fertility damage. While the second tier of cervical cancer testing after a Pap smear or HPV test is harmless, the next stage—a tissue biopsy—can weaken the cervix. A weaker cervix can lead to trouble in future pregnancies, such as causing early labor or, in the worst case, a miscarriage. “If you start sending more women for [follow-up screening], that stacks the odds for more aggressive treatment than she actually needs,” said Mazzucco. This affects younger, pre-menopausal women more than others, since they still have a future of childbearing ahead of them.