Cervical Cancer Screening

What is cervical cancer screening?

Cervical cancer screenings are tests that detect early-stage cervical cancer or precancerous cells in your cervix before you have symptoms. There are three screening methods your healthcare provider may use:

• An HPV test checks for high-risk strains of the human papillomavirus (HPV) that cause cervical cancer.
• A Pap test (Pap smear) checks for abnormal cells in your cervix that are cancerous or that may become cancerous without treatment.
• An HPV/Pap cotest combines an HPV test and a Pap test to check for both HPV and abnormal cells.

Most people should start cervical cancer screenings at age 21 and get them until age 65. This is the case even if you’ve gotten the HPV vaccine. The vaccine prevents most cancer-causing strains of HPV but not all of them.

Even if you’re in between these ages and have never been screened, it’s not too late to start. And the benefits are well worth any dread or jitters about visiting the doctor. Screenings prevent cervical cancer. They allow your healthcare provider to detect and treat precancer in the early stages, preventing the progression to cancer.

How do cervical cancer screenings work?

Your healthcare provider will collect a sample of cells from your cervix with a soft brush and send it to a lab for testing. The lab will check for signs of HPV (HPV test), abnormal cells (Pap test) or both (HPV/Pap cotest).

The U.S. Preventive Services Task Force publishes cervical cancer screening guidelines for people of average risk based on age. You may need more frequent screenings if your risk for cervical cancer is higher than average. Your provider may consider you high-risk if you’re immunocompromised or if you’ve had abnormal results on a previous cervical cancer screening test.

Age 21 to 29

If you’re in this age range, you should get a Pap test, with follow-ups every three years if the results are normal.

Screenings shouldn’t start earlier than age 21, even if you’re already sexually active (and at risk of HPV infection). This is because HPV infections among people in this age group often go away on their own. Also, not all cervical precancers develop into cancers. The ones that do often take several years to do so.

In fact, given how slowly these cancers progress (and the effectiveness of the vaccine), the American Cancer Society recently updated its recommendations for cervical cancer screenings. Its recommendation is to get the HPV test every five years, starting at age 25.

Your healthcare provider (your gynecologist or primary care physician) will recommend the screening schedule and tests that make the most sense for your health.

Age 30 to 65

There are a few options if you’re in this age range. Your healthcare provider may recommend:

• A Pap test, with follow-up Paps every three years if your results are normal.
• An HPV test, with follow-up HPV tests every five years if you test negative for the virus.
• An HPV/Pap cotest, with follow-up HPV/Pap contests every five years if your results are normal.

How do I prepare for a cervical cancer screening?

Your healthcare provider will give you instructions to help you prepare. They may ask that you:

• Do not have vaginal sex for two days before your screening.
• Avoid inserting things into your vagina, like tampons, vaginal creams or lubricants, for two days beforehand.
• Schedule your appointment so it happens on a day after your period has ended.

In some cases, your provider may still be able to do the test during your period. Ask them to advise you.

What are the risks?

You may have light bleeding after your healthcare provider removes cells from your cervix. But the bleeding doesn’t last long. Pap smears and HPV tests are both safe procedures that are essential in the fight against cervical cancer.

What type of results do you get and what do the results mean?

It may take up to three weeks to get your test results. Here’s what they mean:

• Normal/negative. The lab didn’t find abnormal cells. If you had an HPV test, a normal result means you tested negative for the virus.
• Abnormal/positive. The lab found abnormal cells. An abnormal result on an HPV test is the same as testing positive for the virus.
• Unclear/unsatisfactory. The lab can’t tell whether the cells from a Pap test are abnormal or normal. You’ll likely need another Pap test to get clearer results.

If the results are abnormal, what are the next steps?

An abnormal result doesn’t mean you have cervical cancer. In fact, most abnormal cervical cells are related to noncancerous causes, like infection or irritation. Still, you’ll need more tests to know for sure. You may need:

• A physical exam. Your healthcare provider will check for signs of cancer, like swollen lymph nodes. They’ll do a pelvic exam (if they didn’t already do so during your screening).
• A colposcopy. They’ll use a special lighted instrument called a colposcope to take a closer look at the abnormal cells in your cervix.
• A biopsy. Your provider will remove a sample of the abnormal tissue to test it for cancer. Often, they remove the sample at the same time as a colposcopy.

Biopsy results show if abnormal cells are cervical cancer, precancer or unrelated to cancer.

When should I call my doctor?

Contact your healthcare provider if you have questions about cervical cancer screenings. Questions to ask include:

• What is my risk of cervical cancer?
• What tests do you recommend?
• How often should I get screened?
• How should I prepare?
• What do my results mean?