What Is Cervical Cancer Screening?

Cervical cancer screening, which usually includes a Pap smear and/or an HPV test, is an important and necessary preventive procedure for women starting at the age of 21. A Pap test is used to detect cellular abnormalities in the cervix that may lead to cervical cancer, and an HPV test looks for the virus (human papillomavirus) that may cause these abnormalities.

Cervical cancer screening has been found to reduce mortality from cervical cancer by two-thirds.

Types of Testing

Three types of tests are used to screen for cervical cancer, and each one has a specific function to see whether there’s any cancer or precancer in the cervix:

• Pap test: Checks for cells in the cervix that are not normal
• HPV test: Looks for human papillomavirus DNA in the cells from the cervix
• Pap and HPV cotesting: The Pap test can find abnormal cells, but the HPV test provides more information about the cervical cells and the type of HPV infection that can cause cervical cancer. Cotesting is more likely to find abnormal cells or cervical cancer than a Pap test alone is

Purpose of Screening

Cervical cancer used to be the leading cause of death for women in the United States. Over the past 40 years, cervical cancer cases and deaths have decreased thanks to regular screening, which can find cellular abnormalities before they may become cancerous. Not only does screening help find cancerous cells at an early grade or stage, but when it is detected early, it’s easier to treat. 

Recommendation for Testing

The American Cancer Society recently updated its guidelines for cervical cancer screening:

• For women 25 to 29 years old (previously 21 years old), an HPV test should occur every five years. An HPV/Pap cotest every five years or a Pap test every three years is also considered acceptable
• For those 30 to 65 years old, an HPV test every five years is preferred. An HPV/Pap cotest every five years or a Pap test every three years is also acceptable
• For women 65 and older, there is no need for testing if prior tests results were normal

Although Pap tests have resulted in a decrease in cervical cancer rates and deaths, Pap tests have been found to have a propensity to miss precancer and need to be repeated more often, unlike HPV tests, which have a higher sensitivity.

The recent age change from 21 to 25 years old is important change in relation to HPV vaccination. HPV vaccines prevent HPV infections, specifically HPV types 16 and 18, which most often lead to cervical cancer. The vaccine has reduced HPV infections and cervical precancer in young women. Also, in young women, most HPV infections go away on their own. Screening people below 25 often leads to unnecessary treatment, which can have side effects. 

According to a study published in 2012, HPV testing, alone or combined with a Pap test, leads to increased detection of CIN3+ cancerous lesions in the first round of screening, followed by reduced lesions in the second screening. These findings indicate that HPV-based cervical cancer screening is the preferred method and should be used as the primary screening test for women aged 30 and older.

How It's Performed

Both the Pap and HPV tests are performed in a healthcare provider’s office or clinic. During the Pap test, your medical provider will insert a speculum into the vagina. The speculum will spread apart the walls of the vagina to show the cervix, which is located directly above the vagina. With a soft swab, your medical provider will remove cells from the cervix and the backwalls of the vagina. The cells will then be placed in a vial filled with liquid preservative. For an HPV test, your medical provider will also take sample cells.The sample cells will be taken to a lab to be analyzed. 

At the lab, the cells are put on a glass slide, stained, and examined by either a pathologist or a cytotechnologist to see if there are any abnormalities, including bacterial, fungal, and viral infections. The results will be sent to your medical provider within one to three weeks after the test. 

Getting Results

Pap test results fall under three classifications:

• Normal: The cells appear as they should and nothing else needs to be done until the next screening
• Unclear: Your physician is unsure whether the cells are normal or abnormal. If the results fall under this category, your healthcare provider will either do more testing to rule out any other issues or perform another Pap test within six months to a year
• Abnormal: This doesn’t necessarily mean that they’re cancerous, but your practitioner will need to do more tests to determine your next steps. Another Pap test may be required immediately, but if the changes in the cells don’t appear to be too significant, you may wait another six months for another screening. If the test finds significant changes, then your medical professional will do a colposcopy and a biopsy 

An HPV test can be positive or negative. A negative HPV test means you do not have an HPV type that is linked to cervical cancer. Your healthcare provider may tell you to wait five years for your next screening test. A positive HPV test means you have an HPV type that may be linked to cervical cancer. This does not mean you have cervical cancer now, but it could be a warning. Your practitioner may identify the specific HPV type to determine your next steps.

A Word From Verywell

Cervical cancer is one of the more preventable cancers with regular screenings. It’s extremely important for women above 25 to get regular Pap and HPV screenings. This can help detect early grades or stages of cancerous lesions and get treatment early should any abnormalities be found.