Cervical Cancer Facts

Prevention | Pap Test | Before You Have Symptoms | Cervical Cancer Vaccine

Página en español

Cervical Cancer Screening Is Life Saving

Many women think of their annual Pap test in the same way they think about going to the dentist to fill a cavity. Have you ever wondered if this not-so-comfortable procedure is really necessary? If necessary procedure includes a potentially lifesaving one, the answer is yes.

Pap tests are also called Pap smears. They screen for cervical cancer. This is a common type of cancer in women worldwide. Internationally, cervical cancer is second only to breast cancer as the leading cause of cancer deaths in women. In the United States there are very few deaths from this cancer. That's mainly due to regular use of Pap tests. Pap tests can discover changes in the cervix before they become cancerous. The chance of being cured is higher when doctors find the cancer in its early stages before it has spread. And the earlier it's found the better.

Causes of Cervical Cancer

Human papillomavirus (HPV) causes cervical cancer. About 15 strains are directly linked with precancers or cancer. Two of those strains cause more than 70% of all invasive, abnormal growths in the cervix.

HPV infection is more common among women in their late teens and twenties. However, the infection usually doesn't become cancer. HPV strains linked to causing cervical cancer increase the risk of changes that can become cancerous. That is why close follow-up by a doctor is recommended if you have HPV.

Your risk of HPV increases with the number of sexual partners you may have had. Having sexual intercourse before the age of 18 also increases the risk for cancer. Other things that increase the risk of cervical cancer include:

  • poor nutrition
  • poor immune function (such as from HIV/AIDS)
  • smoking

But even women who do not have these risk factors may still get cervical cancer. Therefore, all women should get regular Pap tests.

How Often You Need to Be Screened

You should have a check up with your healthcare provider once a year. The American College of Obstetrics and Gynecology issued new guidelines in November 2009 which call for less frequent Pap tests. The new schedule for Pap tests is:

  • A first Pap screening test at age 21.
  • Between 21 and 29 years of age, screen every 2 years
  • Between 30 and 65-70 years of age, screen every 3 years in low risk women.
    • Women 30 years of age and older who have 3 consecutive negative Pap tests and who are low risk (i.e., have no history of cervical precancerous lesions, are not infected with HIV, are not immunocompromised, and were not exposed to DES in utero, may extend the interval between Pap tests to every 3 years.
    • Women who are high risk should be screened more frequently. A conversation with your healthcare provider will determine how frequently this should be.
    • For all women, continue to have an annual well woman exam
  • Women treated in the past for cervical precancerous lesions or cancer should continue annual screening for at least 20 years.
  • Women age 65-70 who have had 3 or more consecutive negative Pap tests and no abnormal Pap tests within 10 years, may discontinue Pap tests.
  • Cease screening after hysterectomy for documented benign disease. Continue to screen after hysterectomy for cervical precancerous lesions or cancer and those without documentation of any lesions.
  • If using co-testing (Pap + HPV test) for women over 30 years of age, only do so every 3 years if Pap and HPV tests are both negative.

It's best to talk with your doctor about a Pap test schedule that takes into account your personal risk factors.

Getting a Pap Test

Your doctor will usually perform a Pap test and pelvic exam at the same time. During a Pap test, he or she inserts a device called a speculum into your vagina. The speculum holds the vagina open. While it does, the doctor uses a small spatula to gently scrape cells from your cervix. You may feel gentle pressure as the speculum goes in. You may also feel slight discomfort if the speculum is cold. The test usually lasts a few minutes. During a pelvic exam, your doctor inserts his or her fingers into your vagina. At the same time, he or she presses on your abdomen with the other hand. This lets the doctor feel for abnormal lumps or growths. You may feel a slight discomfort during the test. But the test is normally over in a few minutes.

Before the Pap Test

You should avoid these things before your Pap test.

  • Do not douche for at least 2 days (48 hours).
  • Do not have sex for 2 days (48 hours).
  • Do not use a tampon for 2 days (48 hours).
  • Do not use any kind of vaginal products or medicines for 2 days (48 hours).

Ask when you can expect results and how you will receive them. For instance, will you receive results by telephone or in the mail? Knowing how long you will have to wait for results may help you feel less anxious. You may consider calling your healthcare provider for your results.

How the Pap Test Is Done

The Pap test is simple and relatively painless. You can have it right in your healthcare provider's office. You should not have this test during your period. The best time to have a Pap test is 10 to 20 days after the first day of your last period.

A Pap test may feel uncomfortable, but it should not hurt, and it takes just seconds. The doctor uses a tool called a speculum to widen your vagina and examine the upper part of your vagina and cervix, which is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from your cervix and vagina. A specialized doctor called a pathologist looks at the cells at under a microscope to check for cancer.

There are 2 types of Pap test. The difference between the 2 has to do with how the cells are checked after they are taken from your cervix. There is not a difference in how the cells are removed from you.

  • With the regular method, the healthcare provider puts the cell sample on a slide and a pathologist checks it in a lab.
  • With the newer, liquid-based test, the doctor mixes a special liquid with the cells. This helps to preserve the cells for testing so that they can be seen and checked in the lab.

If your Pap test gives a positive result, it means that abnormal cells may be present. In that case, your doctor may order a HPV test. This test determines if high-risk HPV is present. The HPV test can be done along with the regular Pap test for women over age 30. The combined test is not used for women under 30 years old because in most women under 30 who have HPV, the virus is very common, but will go away before it causes any cell changes or symptoms. So testing for the virus may cause a lot of undue worry. Also, the HPV test may be used in certain instances of abnormal Pap tests to see if you need further testing due to concern for precancerous cells on your cervix.

HPV has been shown to cause almost all types of cervical cancer. Now that doctors can test for its presence, it is possible to know which women are at risk of developing cervical cancer and which women have little or no risk of developing cervical disease or cervical cancer in the near future.

What if a Pap Test Is Abnormal?

It's important not to panic if your doctor says that your Pap test results are "abnormal." This term describes cells in the cervix that do not look like normal healthy cells. How abnormal they are, though, varies. The changes in these cells may be classified as mild, moderate, or severe. You might hear your doctor use the terms squamous intraepithelial lesion (SIL). Or your doctor might refer to cervical intraepithelial neoplasia (CIN). Another term used to describe these changes is dysplasia.

SIL and CIN note abnormal cells on the surface of the cervix. They are typically classified as SIL or CIN 1 through 3. Three indicates a large number of abnormal cells in the cervix. These changes may be due to a number of things, including infection or cancer.

If an abnormal growth is confirmed and is mild, your doctor may simply watch it over time for changes. You should have repeat Pap tests to see if the growth returns to normal.

You could have a large growth of abnormal cells. The next step is to look at the abnormal cells more closely. Your doctor might do this with a colposcopy. This is a procedure that uses a type of magnifying scope. Or the doctor may ask for a biopsy or another test.

If the abnormal cells are in danger of spreading, you may have one of several procedures. Cryosurgery destroys precancerous cells with freezing temperatures. Laser therapy uses heat to burn and destroy tissue. Your doctor may also remove a section of tissue with a laser knife, electrical wire, or surgical blade.

It is very rare for a woman to need a hysterectomy to treat these precancerous changes. They can most often be treated in the doctor's office. Or they may be treated in an outpatient setting.

New Screening Tests

Researchers are exploring new screening tools for cervical cancer. The goal is to improve the accuracy of the tests. Reducing the number of incorrect test results will help lower healthcare costs and unnecessary anxiety for women. An example is an automated Pap test called the ThinPrep Pap test. It's been approved by the FDA to use in place of the conventional Pap test. A traditional Pap test contains hundreds of thousands of cervical cells. The laboratory is examining these cells trying to find a dozen or so abnormal ones. The ThinPrep test aims to offer a random sample of cells. It does this by removing blood and other unneeded material from the smear. Then it mixes it with a glue-like fluid for a consistent and clear sample of cells.

The HPV test is another screening tool. The FDA has approved a combination HPV and Pap test for women age 30 and older. Instead of having a separate HPV test, you can have the test done at the same time as your Pap test.

Targeting Those Who Need It Most

The best way to catch and treat early signs of cervical cancer is with a Pap test. Some women, though, who are at high risk may not be able to afford the test. Certain states are addressing this problem. They are using federal and state-funded programs that offer free or low-cost medical care. Some programs go one step further. They give tests through outreach vans that travel to underserved areas. This targets women who may have a hard time getting to or using federal programs.

The Health Resources and Services Administration (HRSA) is a division of the Department of Health and Human Services. It offers information on accessing reduced-cost medical care nationwide. It funds various health services through its Community Access Program. Visit their website to learn about programs in your state.

Related Sites:

return to top of page return to top of page