Recently we published information about the signs and symptoms of cervical cancer. With cervical cancer, early detection is especially important. Over the years, the rate of cervical cancer has decreased due to regular screening. Here are the current guidelines for cervical cancer screening and details about the tests.
Cervical Cancer Screening: Pap and HPV Tests
Each year, more than 13,000 women are diagnosed with cervical cancer in the United States. Yet cervical cancer is one of the most preventable cancers today. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops.
We now know that these cell changes are caused by human papillomavirus, commonly known as HPV. The traditional test for early detection has been the Pap test. For women age 30 and over, an HPV test is also recommended. HPV tests can find any of the high-risk types of HPV that are commonly found in cervical cancer.
Current guidelines for cervical cancer screening are:
- Women should start screening with the Pap test at age 21. (Screening is not recommended for women under age 21.)
Starting at age 30, women have three options available for screening:
- A Pap test alone every three years
- Co-testing with a Pap and HPV test, every five years
- An HPV test alone, every five years
Depending on the results of the Pap and/or HPV tests, a healthcare provider may recommend additional screening or procedures, so some women may be screened more often.
After age 65, women older than 65 who have had adequate prior screening and are not otherwise at high risk can stop screening. Women who have had a hysterectomy (with removal of the cervix) also do not need to be screened, unless they have a history of high-grade precancerous lesions.
The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. When a female has a Pap test, she is positioned on an exam table and a device called a speculum (pictured to the right) is gently inserted to open the vagina. The speculum allows the healthcare provider to view the cervix and upper vagina. Once the provider can see the cervix, a “broom” device or a brush/spatula combination will be used to collect the cells. While the technique is a little different depending on the device chosen, in general, the provider will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect squamous and glandular cells. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.
The Pap test looks for any abnormal or precancerous changes in the cells on the cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:
- Abnormal cell changes
- Precancerous cells changes
- CIN (cervical intraepithelial neoplasia)
- SIL (squamous intraepithelial lesions)
- “Warts” on the cervix
All of these terms mean similar things—it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered “high-risk” types, which means that they have been linked with cervical cancer.
Just because a woman has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often – and possibly do treatment – to prevent further cell changes that could become cancerous over time if left unchecked.
HPV tests can find any of the high-risk types of HPV that are most commonly found in cervical cancer. The presence of any of these HPV types in a woman for many years can lead to cell changes that may need to be treated so that cervical cancer does not occur. The HPV test is done at the same time as the Pap test by using a small soft brush to collect cervical cells that are sent to the laboratory, or the HPV testing sample may be taken directly from the Pap sample.
A word about genotyping: two “high risk” HPV types (also called “genotypes), HPV 16 and HPV 18, are responsible for about 70% of cervical cancers worldwide. Knowing if a woman has these types of HPV gives healthcare providers more insight into her risk for developing cervical cancer.
As of 2018, an HPV test is now an option for primary cervical cancer screening (meaning it can be done alone without a Pap test). The test is followed by a Pap test for women with certain results. Don’t worry about which option is the best one for you: the exact test or tests used is not as important as simply being screened regularly! Your healthcare provider will help you sort out which option is right for you.
What To Do After A Cervical Cancer Diagnosis
If you or a loved one has recently been diagnosed with cervical cancer, our Start Here Guide is a good place for you to start. It can provide you with two actionable steps you can take on the path towards selecting the best treatment. For more helpful resources, including questions to ask your doctor, visit our Cervical Cancer Resource Library.