Cervical Cancer: Screening

What is screening?

Screening means checking for a health problem before a person has symptoms. Screening can sometimes find certain cancers early, when they're small and before they have spread. Cancer that is found early is often easier to treat. The Pap test can find cancer early or in precancer stages. The HPV test can identify infection with one of the HPV types linked to cervical cancer.

What screening tests are used for cervical cancer?

• Pap test. This test is also called a Pap smear. A Pap test screens for cervical cancer and precancer. Regular Pap tests can show changes in cells of the cervix before they become cancer. They can also find cervical cancer in its early stages, when it can be treated most easily. The chance of being cured is higher when doctors find the cancer before it has spread.

• HPV test. This test is used to find signs of human papilloma virus (HPV) infection in the cells of the cervix. The HPV test may be done along with the Pap test for cervical cancer screening in certain age groups.

• Pelvic exam. This exam is often done along with Pap and HPV tests. This can also help find some cancers of the uterus and other parts of the female reproductive system.

How the tests are done

Your healthcare provider will usually do a Pap test, HPV test, and pelvic exam at the same time. To do the tests, he or she inserts a device called a speculum into your vagina. You may feel pressure as the speculum goes in, and slight discomfort if the speculum is cold. The speculum holds the vagina open while the healthcare provider uses a small spatula or brush to gently scrape cells from your cervix. The cells that are removed from the surface of the cervix are then sent to a lab to be tested. The test results may show that the cells are normal. Or the results may show infection, inflammation, abnormal cells, precancer cells, or cancer cells.

During a pelvic exam, your healthcare provider inserts his or her fingers into your vagina while he or she presses on your belly (abdomen) with the other hand. This is done to feel for abnormal lumps (masses) or growths. You may feel a slight discomfort during the exam. The exam only takes a few minutes.

Who should have Pap tests?

Cervical cancer screening should begin at 21 years old. A woman should talk with her healthcare provider about when and how often to have cervical cancer screening and a pelvic exam.

All women should seek expert medical advice about:

• When they should begin screening

• How often they should be screened

• When they can stop cervical screenings, especially if they are at higher risk of cervical cancer

General guidelines from the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) are below.

Women ages 21 to 29:

• Screening with Pap tests every 3 years

• No HPV testing, unless there is an abnormal Pap test

Women ages 30 to 65:

• Screening every 5 years with an HPV test and a Pap test (called co-testing)

• OR Screening with the Pap test only, every 3 years

• Possible screening more often if you have risk factors such as a human immunodeficiency virus (HIV) infection, a weak immune system, DES exposure before birth, or previous cervical cancer

Women ages 65 and older can stop screening if:

• They have had 3 consecutive Pap tests or 2 co-tests in the last 10 years with normal results and are not at high risk for cervical cancer (Source: ACOG)

• They have had regular screening with normal results for the last 10 years and have no history of precancer in the last 20 years (Source: ACS)

You may not need screening if you had surgery to remove the uterus and cervix (total hysterectomy), unless it was done to treat cervical precancer or cancer.

Women who have been vaccinated against HPV should follow the guidelines for their age group. 

What if a Pap test is abnormal?

Ask your healthcare provider to explain the results of the test to you. It’s important not to panic if your doctor says that your Pap test results are abnormal. This simply means that there are cells in the cervix that do not appear to be normal healthy cells. Just how abnormal they are varies. These changes may be classified as mild, moderate, or severe.

Your doctor may use the terms atypical squamous cells of uncertain significance (ASC-US) or squamous intraepithelial lesion (SIL). Another term used to describe these changes is dysplasia. ASC-US on a Pap smear will usually be rechecked with another Pap test in a year. Another option is to test for HPV. SIL means abnormal cells were found in the cells taken from the surface of the cervix. They are typically classified as SIL 1 through 3. The higher numbers mean a larger number of more seriously abnormal cells. These changes may be due to a number of factors. The factors may include an infection, inflammation, precancer, or cancer. CIN3 is the most serious precancer.

If an abnormal growth is confirmed and is mild, your doctor may simply watch you closely over time. HPV testing may also be done to see if the problem is caused by HPV infection. You should have repeat Pap and HPV tests to see if the changed cells return to normal.

If you have a large number of abnormal cells, the next step is a colposcopy. This is a procedure using a special magnifying scope to closely examine the cervix. Or you may have a biopsy. This removes more tissue to be checked for abnormal cells.

In most cases, precancer can be treated in the doctor’s office or in a hospital as an outpatient. This means you go home the same day. It is rare that a major surgery (such as a hysterectomy) is needed for precancer of the cervix.

Getting tested with no health insurance

Some women who are at high risk for cancer of the cervix may be less able to afford the screening tests. Tests for breast cancer and cervical cancer are available to many women through the National Breast and Cervical Cancer Early Detection Program. This program offers breast and cervical cancer testing to women with no health insurance for free or at little cost. Each state runs its own program. Contact your state or your county Department of Health to find a program near you. There may also be other private or volunteer clinics available in your area that might provide this screening free or at a much reduced cost.