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.

There are a few different ways to screen:

• Pap test – This is the most commonly used test for screening. It 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 look at the cells under a microscope to see if they are abnormal.
• HPV test – HPV stands for “human papillomavirus.” It is the virus that causes cervical cancer. An HPV test involves testing cells from the cervix for certain types of HPV.
• Combination test – This involves doing a Pap and HPV test at the same time.

For both types of tests, your doctor will need to 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 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.

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.

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 it turns out that is not necessary. Pap tests work fine even if you have had sex recently.

Your doctor might recommend scheduling your test 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.

That depends on how old you are and what the results of your past Pap tests have been.

• 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 (with the most recent test within the past 5 years)

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.

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.

Yes. Getting the HPV vaccine lowers your chances of getting cervical cancer. But it does not completely protect you. You should still be screened for cancer or precancer.

First, you should know that 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 have 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.” Tissue from the biopsy can go to the lab and be checked for anything abnormal.

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