Patient education: Cervical cancer screening tests (The Basics)

What is cervical cancer screening? — Screening tests look for cancer cells in the cervix. The cervix is the bottom part of the uterus, where it meets the vagina (figure 1).

Screening tests also look for cells that could turn into cancer, called "precancer." They can find cervical cancer and precancer in the early stages, when it can be treated or even cured.

What tests are used to screen for cervical cancer? — There are a few different ways to screen:

●Pap test – This is sometimes called a "Pap smear." It involves taking cells from the surface of the cervix and sending them to a lab. Then, an expert will check the cells under a microscope.

●HPV test – HPV stands for "human papillomavirus." Some types of this virus can cause cervical cancer. An HPV test involves testing cells from the cervix for certain types of HPV.

●Combination test – This means doing a Pap and HPV test at the same time.

What happens during a Pap or HPV test? — For both types of tests, your doctor will take cells from the surface of your cervix. To do this, they will gently insert a device called a "speculum" into your vagina. The device helps to push apart the walls of your vagina so that the doctor can see the cervix. Then, they will use a small tool to lightly scrape cells from the surface of your cervix. The tool looks like a small spatula or brush. This might be a little uncomfortable, but usually does not hurt.

When should I start being screened for cervical cancer? — Most experts recommend that you start having Pap tests when you turn 21. Some experts recommend HPV tests instead of Pap tests, starting at age 25. But this option might not be available in many places. Your doctor or nurse can talk to you about your options.

You should start getting Pap tests at the recommended age, whether or not you have ever been sexually active. Also, you do not need to start cervical cancer screening before age 21, even if you became sexually active at a younger age.

What should I do to prepare for a Pap or HPV test? — You do not need to do anything special to prepare. People sometimes hear that they should not have sex or put anything in their vagina for 2 days before a Pap test, but this is not necessary. Pap tests work fine even if you have had sex recently.

Your doctor might recommend scheduling your test for when you do not expect to have your period. But don't worry if you do have your period on the day of the test. Screening can usually still be done even if you are bleeding. Your doctor can talk with you and let you know what to do.

How often should I be screened for cervical cancer? — That depends on how old you are and the results of your past tests.

●If you are age 21 to 29, you should have a Pap test every 3 years. Or, if your doctor recommends HPV testing instead, you should have a test every 5 years beginning at age 25.

●If you are age 30 or older, you can have a Pap test every 3 years. The other options are having an HPV test every 5 years or a combination Pap and HPV test every 5 years.

●If you are age 65 or older, you can stop having Pap tests if:

•You had Pap tests done regularly until you turned 65.

•You had 3 normal Pap tests in a row, or 2 normal combination Pap and HPV tests over the past 10 years (if the most recent test was within the past 5 years).

•You do not have other medical conditions that could weaken your immune system – These include taking certain medicines or having HIV.

You might also get a Pap test for reasons other than cervical cancer screening. For example, if you have abnormal vaginal bleeding, your doctor might do a Pap test to try to figure out the cause.

Do I need to be screened for cervical cancer if I had a hysterectomy? — If you have had surgery called a "hysterectomy" to remove your uterus, ask your doctor if you need to keep getting screened. After a hysterectomy, you probably do not need screening if:

●Your cervix was removed along with your uterus, and

●You did not have cervical cancer or precancer (sometimes called "dysplasia")

If you're not sure, your doctor can help you figure out if you need to continue screening.

Do I need to get screening tests if I had the HPV vaccine? — Yes. Getting the HPV vaccine lowers your chances of getting an HPV infection that could lead to cervical cancer. But it does not completely protect you. You should still be screened for cancer or precancer.

What if I have an abnormal Pap test result? — Abnormal Pap tests are common, and most people with an abnormal Pap test do not have cancer. If your Pap test has cells that look abnormal, your doctor or nurse can do more tests to figure out what is causing this. They will decide what to do based on your age, what your Pap test shows, and the results of any other tests you had.

Follow-up tests might include:

●An HPV test – If you haven't already had an HPV test, your doctor might order one. They might be able to do this on the cells already taken during your Pap test.

●Another Pap test in 12 months – Sometimes, if you wait a year and have another Pap test, you could find that the abnormal cells are back to normal. You might also have an HPV test at the same time.

●A colposcopy – For this test, the doctor or nurse will use a speculum to look at your cervix, just like during a Pap test. But they will look more closely using a device that looks like a microscope. It allows the doctor or nurse to see the cervix in more detail. During this test, the doctor or nurse might also take tiny samples of tissue from the cervix. This is called a "biopsy." The tissue samples are checked in a lab.

If you do have cervical cancer or precancer, there are effective treatments available. If your condition was found early, there is a good chance that you can be cured.

What if my HPV test comes back positive? — Most people who have sex will be exposed to HPV at some point, and having HPV does not mean that you will definitely get cancer. For most people, HPV infection goes away on its own. But for some people, it does not. Long-lasting HPV infection increases your risk of cancer over time.

If your HPV test comes back positive, your doctor or nurse will talk with you about what to do. This will partly depend on whether your Pap test results were abnormal. If your HPV test is positive but your Pap test is normal, you might need to repeat the tests in 1 year so your doctor can see if anything has changed.

More on this topic

Patient education: Cervical cancer (The Basics)
Patient education: Vaginal cancer (The Basics)
Patient education: Human papillomavirus (HPV) (The Basics)
Patient education: Human papillomavirus (HPV) vaccine (The Basics)
Patient education: Cancer screening (The Basics)

Patient education: Cervical cancer screening (Beyond the Basics)
Patient education: Colposcopy (Beyond the Basics)
Patient education: Management of a cervical biopsy with precancerous cells (Beyond the Basics)
Patient education: Cervical cancer treatment; early-stage cancer (Beyond the Basics)
Patient education: Fertility preservation in early-stage cervical cancer (Beyond the Basics)
Patient education: Follow-up of high-grade or glandular cell abnormal Pap tests (Beyond the Basics)