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's found early is often easier to treat.

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 pre-cancer. Regular Pap tests can show changes in cells of the cervix before they become cancer. These are called pre-cancers. They can also find cervical cancer in its early stages, when it's small, hasn't spread, and is easier to treat. The chance of being cured is higher when cancer is found before it has spread.

• HPV test.This test is used to find signs of human papillomavirus (HPV) infection in the cells of the cervix. Certain types of HPV are linked to cervical cancer. The HPV test is 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. It 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. You lie on a table with your feet in stirrups and your knees apart and bent. A device called a speculum is put into your vagina. You may feel pressure as the speculum goes in and slight discomfort if it's cold. The speculum holds your 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 inflammation, abnormal cells, pre-cancer cells, or cancer cells. The HPV test is done on the cells, too. This shows if there's HPV infection in the cells.

During a pelvic exam, your healthcare provider will put their fingers into your vagina and press 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. It only takes a few minutes.

Who should have Pap tests?

The American Cancer Society (ACS) recommends cervical cancer screening start at age 25. The American College of Obstetricians and Gynecologists (ACOG) says you should start when you're 21 years old.

Talk with your healthcare provider about:

• When you should start cervical cancer screening and pelvic exams

• How often you should be screened

• When you can stop cervical screenings, especially if you're at higher risk of cervical cancer

General guidelines from ACS and ACOG vary a little.

American Cancer Society:

Women ages 21 to 29 should be screened with Pap tests every 3 years and no HPV testing.

Women ages 30 to 65 should be screened:

• Every 5 years with an HPV test and a Pap test (called co-testing)—this is preferred

• Another option is only a Pap test every 3 years or only an HPV test every 5 years

Women ages 65 and older can stop screening if:

• They have had 3 consecutive Pap tests and no history of cervical changes

• They've had 2 negative co-tests in the last 10 years, and the most recent test was done within the last 5 years

• They had a hysterectomy that included removing the cervix

Women who have had cervical cancer or a serious pre-cancer should continue screening for 20 years after surgery.

ACS and ACOG both say:

• Women at high risk for cervical cancer because of HIV infection, a weak immune system, or DES exposure before birth, or if they had cervical cancer in the past, may need to be screened more often and should follow the recommendations of their healthcare providers.

• 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 your test results to you. It’s important not to panic if your healthcare provider says that your Pap test results are abnormal. This just means there are cells on your cervix that don't look like normal healthy cells. Just how abnormal they are varies a lot. These changes may be classified as mild, moderate, or severe.

Your healthcare provider may use any of these terms to describe the changes:

• Atypical squamous cells of uncertain significance or ASC-US

• Squamous intraepithelial lesion or SIL

• Cervical intraepithelial neoplasia or CIN

• Dysplasia. 

ASC-US on a Pap smear will usually be rechecked with another Pap test in 6 months to a year. Another option is to test for HPV and use the information from both tests to decide on the next steps. 

SIL means abnormal cells were found in the cells taken from the surface of the cervix. They're usually classified as low-grade SIL (LSIL) or high-grade SIL (HSIL).

• In LSIL, the cells look mildly abnormal. This might also be called CIN1 and mild dysplasia. It might go away without treatment.

• HSIL means there are seriously abnormal cells. They are less likely to go away on their own and are more likely to become cancer over time it they aren't treated. This is also called CIN2 or CIN3 and moderate to severe dysplasia.

 Cervical cell changes may be due to a number of factors, such as infection, inflammation, pre-cancer, or cancer. CIN3 is the most serious pre-cancer.

Next steps

If an abnormal growth is confirmed and is LSIL, CIN1, or mild dysplasia, your healthcare provider 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 HSIL, CIN2 or 3, or moderate to severe dysplasia, the next step is a colposcopy. This allows your provider to closely examine your cervix using a special magnifying scope. Or, a biopsy may be done to remove more tissue to be checked for abnormal cells.

In most cases, pre-cancer can be treated in the healthcare provider's office or in a hospital as an outpatient. This means you go home the same day. It's rare that a major surgery, like hysterectomy, is needed for pre-cancer 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.