Cervical Cancer Screening (Pap Test)
What is it?
- A Pap test detects cell changes that may lead to cervical cancer.
What is a Pap test?
A Pap test (also called cervical cytology) is a test performed during a pelvic exam. A healthcare provider takes cells from the cervix, the lower part of the uterus (womb), to check for pre-cancerous and cancerous cells.
A Pap test detects cell changes that can develop on the cervix. If these cell changes are not detected, they can lead to cervical cancer. Cervical cancer can almost always be prevented. It is important to have regular Pap tests and follow any recommendations from your healthcare provider.
Is a Pap test (cervical cytology) the same as a pelvic exam?
A Pap test is not the same as a pelvic exam, but it may be done as part of a pelvic exam. During a pelvic exam, a healthcare provider looks at the vagina and cervix using an instrument called a speculum. Also, as part of the pelvic exam, the healthcare provider usually performs a bimanual examination where he/she feels the different reproductive organs (cervix, uterus, vagina, ovaries, and fallopian tubes) to check their shape and size.
What causes cervical cancer?
Most cervical cancer is caused by certain types of human papillomavirus (HPV), which is a virus that can be spread during sexual contact. There are multiple strains (types) of HPV that can infect the genital area. About a dozen of these can cause cancer.
Most adults will have an HPV infection at some time during their lives. There are two categories of HPV:
- Low-risk strains: Low-risk strains of HPV can cause warts on the genitals. Warts can be itchy, embarrassing, and unpleasant, but these strains are considered low-risk because they do not cause cancer.
- High-risk strains: High-risk strains do not cause warts but can, rarely, cause cancer. Most of the time, when someone is exposed to and infected with HPV, the infection will not cause any problems and the body will clear it naturally without any treatment. HPV sometimes causes cervical cell changes that do not clear up on their own, and in a few cases, these cells will lead to cancer if not treated early.
To learn more about HPV, view the HPV fact sheet.
How is a Pap test done?
A healthcare provider uses an instrument called a speculum to widen the opening of the vagina so that the cervix and vagina can be examined. A small plastic brush is used to collect cell samples from the cervix. The sample is sent to a laboratory for testing.
How do I get ready for a Pap test?
To ensure a Pap test is as accurate as possible, for 48 hours before a Pap test, you should not:
- Have sex.
- Use tampons.
- Use vaginal lubrication.
- Insert creams, suppositories, or medication into the vagina.
- Use sprays or powders in or near the vagina.
Also, you should not schedule a Pap test while on the heavy flow days of your period.
How often should women have Pap tests?
The frequency of Pap tests is not the same for everyone, and depends on factors such as a woman’s age, health history, recent Pap test results, and whether or not she has had HPV. Most women between age 21 and age 30 should have a Pap test every three years, assuming their previous Pap test results were normal. Pap tests should not be performed in women younger than 21 years of age.
After age 30, women may have a test for HPV infection and a Pap test (known as co-testing). If both tests are negative and if previous Pap tests were normal, most women over 30 should have a Pap and HPV test again in five years.
After age 65, most women may no longer need Pap tests if their last three Pap tests were normal, they are not at high risk for cervical cancer, and they have gone 10 years without an abnormal test.
Talk to your healthcare provider about how often and which type of testing is best for you.
Do all women need Pap tests?
Women who have had a total hysterectomy (which means the uterus, fallopian tubes, and cervix were removed) may no longer need to have Pap tests. If the hysterectomy was done because of cervical cancer or precancerous cell changes, she may still need Pap tests.
Talk with your healthcare provider to understand what is recommended for you.
What if the Pap test is abnormal?
When a Pap test is abnormal, it usually does not mean that a woman has cancer. The test results may not be normal for several reasons:
- There is a cervical HPV infection present, and it causes an abnormal Pap test result. HPV infection can resolve over time without any treatment, and many times any abnormal cells detected then return to normal without any treatment.
- There are abnormal cells detected due to infection, inflammation from sex or a diaphragm, and even changes associated with her period. These factors can cause an abnormal Pap test but do not mean there are cancer or pre-cancer cells present.
- There are cancer or pre-cancer cells present and further testing may be needed.
- There is an error in the lab in looking at the cells of the Pap test.
It is important to find, carefully watch, and sometimes treat pre-cancers. If needed, treatment can prevent pre-cancer from becoming cancer. Your healthcare provider may suggest having the test or getting other tests. Additional tests can include:
- Colposcopy: A healthcare provider uses a tool with a light and microscope, called a colposcope, to examine the cervix for cells that are not normal. If there are abnormal cells, the healthcare provider will probably perform a biopsy.
- Biopsy: A healthcare provider takes a small piece of tissue from the cervix, and it is sent to a lab for study.
- Additional tests can be done to see what type (strain) of HPV is present, as some types are more likely to cause cancer than others. Sometimes a healthcare provider uses these additional HPV tests to help decide the best "next step."
It is important to follow up with your healthcare provider about any tests or treatment that are recommended. More information about cervical cancer can be found here.
What is an HPV test?
Pap tests can be done alone or in combination with an HPV test, a test of the cells of the cervix that checks for high-risk HPV. HPV tests are recommended for:
- Women who have abnormal Pap test results. Knowing if a woman has high risk HPV helps her healthcare provider know whether she is more at risk for cervical pre-cancers and cancers over time.
- Women aged 30 years or older together with a Pap test.
HPV tests are not recommended for routine use with women under age 25 because HPV infections in this age group are very common and usually clear quickly on their own without any treatment. In women aged 30 and older, HPV infections are less likely to be new, short-lived infections so HPV testing may help to determine which women need closer follow-up or treatment.
Besides Pap tests, what can be done to reduce cervical cancer risk?
There are vaccines (shots) to protect against HPV. They are effective at blocking infection with the HPV types found with most cases of cervical cancers. Women who receive the full series of HPV vaccines still need screening for cervical cancer and pre-cancer as recommended earlier. The HPV vaccine is best if the vaccine is received before a woman begins having sex, and is recommended in early adolescence. Ask your healthcare provider about the HPV vaccine.
Did You Know? (Pap Test)
Content last reviewed on March 19, 2019