Cervical Cancer Screening (Pap Test)
What is a Pap Test?
A Pap test (or Pap smear) checks the cervix for abnormal cell changes. The cervix is the lower part of the uterus (womb), which opens into the vagina. Cell changes can develop on the cervix that, if not detected, can lead to cervical cancer. Cervical cancer can almost always be prevented, and having regular Pap tests is the key.
Is a Pap test the same as a pelvic exam?
No, although a Pap test may be done as part of a pelvic exam. During a pelvic exam, a health care provider feels the reproductive organs (cervix, uterus, vagina, ovaries, and fallopian tubes) to check their shape and size.
When should women start getting Pap tests?
Most women should start getting Pap tests at age 21.
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What causes cervical cancer?
Cervical cancer is caused by certain types of the human papillomavirus (HPV), one of the most common sexually transmitted infections in the world. More than half of sexually active people will get genital HPV in their lifetimes. At any set time, approximately 20 million Americans have a genital HPV infection.
Most cases of HPV do not cause problems and the body is able to clear them naturally. HPV sometimes causes cervical cell changes that do not clear on their own, and in a few cases these cells will lead to cancer if not found with a Pap test.
There are many types of HPV, including those that cause cervical cancer. Other types of HPV, not related to cancer, can cause genital and anal warts.
How to get ready for a Pap test
To make a Pap test as accurate as possible, there are several things women are recommended to avoid. For 48 hours before a Pap test, do not:
- Have sex
- Use tampons
- Use vaginal lubrication
- Insert creams, suppositories, or medication into the vagina
- Use vaginal sprays or powders
Also, do not schedule a Pap test while on your period.
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How often should women have Pap tests?
This is not the same for everyone, and depends on things like a woman's age, health history, recent Pap test results, and whether or not she has HPV. Ask your health care provider how often you should have a Pap test. Most women can have a Pap test every two years. After age 30, women who have three consecutive, normal Pap tests can often go three years between their Pap tests, but those decisions should be made after consulting with her health care provider.
Do all women need Pap tests?
After age 65, women may no longer need Pap tests if they have three consecutive, normal Pap tests and have gone 10 years without an abnormal test.
Women who have had a total hysterectomy (which means the cervix was removed) may no longer need to have Pap tests. If the hysterectomy was done because of cervical cancer or precancerous cell changes, then Pap tests are still needed. Check with your health care provider to see what he/she recommends for you.
How is a Pap Test Done?
A health care provider uses an instrument called a speculum that goes inside the vagina and opens, so the cervix can be seen. A small stick or brush is used to take cell samples from around, and inside, the cervix. The sample is sent to a lab where it is examined under a microscope to see if any abnormal cells are present.
How does someone get HPV?
HPV is passed by direct skin-to-skin contact during vaginal, anal, and oral sex with someone who has this infection. Most cases of HPV are spread by partners who do not have visible signs or symptoms and do not know they have the virus. A person can have HPV for many years without knowing.
What if the Pap test is abnormal?
Pap tests can be abnormal for different reasons including yeast or other infections, recently having vaginal sex, tampon use, and douching. Sometimes an abnormal Pap test indicates the presence of abnormal cell changes of the cervix.
If a Pap test is abnormal but it is not clear why, a woman may simply have another Pap test done in a few months. Or, her health care provider may want to do a test for HPV (see next section for more on these tests).
If the Pap test indicates abnormal (precancerous) cells are present, a woman is usually referred for a follow-up diagnostic procedure known as a colposcopy where the cervix is examined with a special microscope that remains outside the body. Small samples (called biopsies) are taken of any areas that look suspicious.
Abnormal cervical cell changes are usually not dangerous, and most cases do not result in cancer. Treatment depends on the Pap test results and, if an HPV test was done, the results of that test. Mildly abnormal cell changes typically clear up naturally, so frequent follow-up exams may be done rather than treatment. When treatment is needed, it is usually handled on an out-patient basis and is almost always effective in preventing cervical cancer.
What about HPV tests?
Pap tests can be done in combination with an HPV test, a special test that determines if a woman has a type of HPV that can cause cervical cancer.
HPV tests are approved for use (along with a Pap test) for:
- Women age 21 and older who have unclear Pap test results. Knowing if a woman has HPV helps health care providers know which women are most at risk for cervical precancers and cancers
- Cervical cancer screening for women ages 30 and older.
HPV tests are not approved for routine use with women under age 30 because HPV infections in this age group are very common but tend to clear quickly. In women 30 and older, HPV infections are less likely to clear on their own, so HPV tests help to determine which women need more follow-up.
Besides Pap tests, what can be done to reduce cervical cancer risk?
There are two vaccines to protect against HPV. Both are effective at blocking infection with the HPV types found with most cases of cervical cancers and are recommended for girls ages 11-12, with "catch up" vaccine for females ages 13-26 who have not previously been vaccinated against HPV. Women who receive an HPV vaccine still need Pap tests.
Office on Women's Health
National Institutes of Health
Centers for Disease Control and Prevention Cervical
Content last reviewed on August 16, 2016