Cervical Cancer Screening
Cervical Cancer Screening
Cervical cancer screening can find high-risk HPV infections and abnormal cervical cells before they turn into cancer. Finding and treating precancerous changes is one of the reasons cervical cancer is highly preventable. Screening recommendations depend on your age, health history, previous test results, and the type of screening test used.
What tests are used to screen for cervical cancer?
There are three main approaches to cervical cancer screening.
HPV test
An HPV test looks for infection with high-risk types of human papillomavirus that can cause cervical cancer. HPV testing can identify people who may be at increased risk of developing abnormal cervical cells, even before those changes can be seen.
Pap test
A Pap test, also called a Pap smear, collects cells from the cervix and examines them for abnormal changes. The goal is to identify precancerous cells so they can be monitored or treated before they develop into cancer.
HPV and Pap cotesting
Cotesting performs an HPV test and Pap test at the same time. Different medical organizations recommend slightly different screening strategies, but HPV-based testing has become an increasingly important part of cervical cancer screening.
When should cervical cancer screening begin?
Cervical cancer screening recommendations can vary depending on which medical guideline is followed. The American Cancer Society recommends beginning cervical cancer screening at age 25, with primary HPV testing every five years as the preferred approach through age 65. If primary HPV testing is not available, HPV/Pap cotesting every five years or a Pap test every three years are acceptable alternatives. Other U.S. guidelines have recommended beginning Pap testing at age 21. Because recommendations continue to evolve, your healthcare provider can help determine which screening schedule is appropriate for you.
How often do I need cervical cancer screening?
How often you need screening depends on the test being used. Under American Cancer Society guidelines for average-risk people ages 25 through 65, options include:
Primary HPV testing every 5 years, which is preferred
HPV/Pap cotesting every 5 years
Pap testing alone every 3 years
You do not need cervical cancer screening every year if your previous results are normal and you are following one of these recommended schedules. Your healthcare provider may recommend more frequent testing if you have certain risk factors or have had abnormal results.
Do I still need screening if I received the HPV vaccine?
Yes. The HPV vaccine protects against the HPV types responsible for most cervical cancers, but it does not protect against every cancer-causing HPV type. People who have received the HPV vaccine should continue cervical cancer screening according to recommended guidelines. Current screening recommendations do not differ based solely on whether someone has been vaccinated against HPV.
When can cervical cancer screening stop?
Many people can stop routine cervical cancer screening after age 65 if they have had adequate normal screening results and do not have a history of serious cervical precancer or cervical cancer. Screening may need to continue beyond age 65 if you:
Have not been adequately screened previously
Have a history of significant cervical precancer
Have had cervical cancer
Have certain other high-risk conditions
Do not stop screening simply because you have reached a certain age without first discussing your screening history with your healthcare provider.
Do I need screening after a hysterectomy?
It depends on the type of hysterectomy you had and your medical history. If you had a total hysterectomy, which removes both the uterus and cervix, for reasons unrelated to cervical cancer or serious cervical precancer, you may no longer need routine cervical cancer screening. If your cervix was not removed, you generally still need screening. You may also need continued surveillance if you have a history of high-grade cervical precancer or cervical cancer, even if your cervix has been removed. Ask your healthcare provider whether cervical screening is still appropriate for you.
What happens during a Pap or HPV test?
Cervical cancer screening is usually performed during a pelvic examination. A healthcare provider gently inserts a speculum into the vagina so the cervix can be seen. A small brush or other device is then used to collect cells from the cervix. The sample is sent to a laboratory for HPV testing, Pap testing, or both. The collection itself usually takes only a few minutes. You may feel pressure or mild discomfort, but the procedure should not be severely painful.
Can HPV testing be self-collected?
Self-collection is becoming an option for some HPV screening. The FDA has approved certain HPV tests that allow some patients to collect their own vaginal sample rather than having a clinician collect a cervical sample during a pelvic examination. The first approvals allowed self-collection in healthcare settings for people who could not or did not want to undergo a pelvic examination. Availability and eligibility can vary, so ask your healthcare provider whether an approved self-collection option is available and appropriate for you.
What does a positive HPV test mean?
A positive HPV test means that a high-risk type of HPV was detected. It does not mean that you have cervical cancer. HPV infections are extremely common, and many clear without treatment. The next step depends on the specific HPV result, your Pap test results, your age, and your previous screening history. Your healthcare provider may recommend repeat testing, additional laboratory testing, or colposcopy.
What does an abnormal Pap test mean?
An abnormal Pap test means that some of the cells collected from your cervix look different from normal cells. This does not necessarily mean that you have cancer. Many abnormal cervical cell changes are mild and may return to normal without treatment. Others may represent precancerous changes that need to be monitored or removed. Your healthcare provider will recommend the appropriate follow-up based on the type and severity of the abnormality.
What is a colposcopy?
A colposcopy is a procedure used to examine the cervix more closely after certain abnormal screening results. During the procedure, a healthcare provider uses a magnifying instrument called a colposcope to look at the cervix. The colposcope remains outside the body. If an abnormal area is identified, the provider may take a small tissue sample, called a biopsy, for examination under a microscope. A colposcopy does not necessarily mean that cancer is suspected. It is commonly used to evaluate abnormal cervical screening results and identify precancerous changes.
Who may need a different screening schedule?
Routine screening guidelines are intended for people at average risk. You may need earlier, more frequent, or longer screening if you:
Have previously had cervical cancer
Have a history of high-grade cervical precancer
Have HIV
Have a weakened immune system
Were exposed to DES before birth
Have certain persistent abnormal HPV or Pap test results
Your healthcare provider can develop a screening plan based on your individual history.
Staying up to date with screening
Cervical cancer screening is unusual because it can do more than find cancer early—it can help prevent cancer from developing at all. HPV testing and Pap testing can identify high-risk HPV infections and precancerous cervical changes, allowing those changes to be monitored or treated before they progress.
Ask your healthcare provider when your next cervical cancer screening test is due, especially if you are unsure which test you previously received or when it was performed. Even if you have been vaccinated against HPV, staying up to date with screening remains an important part of cervical cancer prevention.