Cervical Cancer Screening: Pap Tests, HPV Tests and How Often to Be Screened

What it involves

MedlinePlus explains that cervical cancer is cancer that starts in the cells of the cervix, the lower, narrow end of the uterus. Before cells become cancer they look abnormal, and these are called precancers. Almost all cervical cancers are caused by a long-lasting infection with high-risk human papillomavirus, or HPV. Screening tests look for abnormal cells or for high-risk HPV so treatment can come early.

Who this is for

• Women starting screening for the first time or unsure when their last test was.
• Patients who were told their last Pap or HPV test was abnormal and need follow-up.
• Women over 30 trying to understand whether they need a Pap, an HPV test or both.
• Patients who have had a hysterectomy or are over 65 and want to know if they can stop.

What to expect

• A review of your age, your past screening results, your health history and any symptoms
• A conversation about which test fits your age, and a referral to a women's health provider where a pelvic exam is needed
• An explanation of how a Pap or HPV test result will reach you and what each result means
• A follow-up plan if a result is abnormal, which may involve a specialist

Two tests, two jobs

MedlinePlus describes two screening tests, both done on a sample of cervical cells collected with a swab. A Pap test, also called a Pap smear, checks for abnormal cells so they can be treated before they become cancer. An HPV test checks for the high-risk HPV infections that can cause it. A cotest uses both together. A provider decides which approach fits your age. Many women have no symptoms at all, which is why screening happens on schedule rather than when something feels wrong.

What the Pap test visit is like

The encyclopedia describes the process. You lie on a table with your feet in footrests, a provider gently inserts a speculum to see the cervix, and cells are collected and sent to a lab. Most people feel only mild discomfort, similar to menstrual cramps, and may bleed a little afterward. For 24 hours before the test, avoid douching, intercourse and tampons. If you have unexpected bleeding, do not cancel without asking, because your provider can decide whether the test can still be done.

How often, and when you can stop

The encyclopedia notes that experts disagree on when and how often to test. Some recommend a Pap every 3 years from age 21, others a primary HPV test from 25. At 30 and older with no recent abnormal result, the options are a Pap every 3 years, an HPV test every 5 years, or both every 5 years. Most people can stop after 65 if past tests were normal, and a total hysterectomy done for a reason other than cancer may end the need. Ask before you stop. Screening is easier to keep up when it is part of a yearly checkup, and the Wellington annual physical page describes how that visit works.

What an abnormal result means

An abnormal result is not a cancer diagnosis. MedlinePlus lists common findings such as ASC-US and LSIL, which are mild changes that often come from an HPV infection, and more serious findings such as HSIL that may point to a precancer or cancer. Next steps range from repeat testing to colposcopy, an exam of the cervix with a magnifying device, and sometimes a small biopsy. Those procedures are done by a specialist, and the practice can refer you and keep track of the results.

Prevention beyond screening

MedlinePlus says almost all cervical cancer can be prevented by HPV vaccination, routine screening and the right follow-up after an abnormal test. Vaccination works best before exposure to HPV. The practice does not list vaccines among its services, so ask the office where to get it. Not smoking lowers risk, and correct condom use reduces the chance of HPV infection but does not remove it. The STI testing guide covers related testing, and the quitting smoking guide helps with the smoking part.

Symptoms that should not wait for a screening date

Early cervical cancer usually causes no symptoms. When it does, MedlinePlus lists vaginal bleeding that is not normal for you, such as bleeding after sex or between periods, watery discharge with a strong odor or blood, and pelvic pain or pain during sex. Any of these needs an appointment now, not at the next screening interval. The abnormal uterine bleeding guide and the pelvic pain guide describe the visit.

Sources

• MedlinePlus: Cervical Cancer (health topic)
• MedlinePlus: Pap test (encyclopedia)
• MedlinePlus: Cervical Cancer Screening (health topic)