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Cervical Cancer Screening

Cervical Cancer Screening

Topic Overview

What is screening for cervical cancer?

A Pap test, or Pap smear, is the most effective screening test for cervical cancer. It's often part of a pelvic exam. Regular testing can help your doctor find and treat abnormal cell changes on your cervix before they develop into cancer.

Women ages 30 to 64 are encouraged to get a human papillomavirus (HPV) test at the same time as a Pap test. The virus can cause cervical cancer and changes in the cervix that can lead to cancer. Certain types of HPV raise the risk of cervical cancer.1

Even if you've already had the HPV vaccine, you still need Pap tests. That's because the vaccine doesn't protect you from all types of HPV. Women who have had the HPV vaccine should follow the same Pap test schedule as women who have not had the vaccine.

Women should start having Pap tests at age 21.2, 1 If you are younger than 21 and are sexually active, it's still a good idea to have regular testing for sexually transmitted infections.

These guidelines apply to women who have never had a serious abnormal Pap test result. If you don't know if you have ever had such a result, talk with your doctor.

How often do you need tests for cervical cancer?

Women 21 to 29

You can have Pap tests every 3 years.2, 1

If any of your tests are abnormal, you may need to be tested more often.

Women 21 to 29 usually aren't tested for HPV, because they are at low risk of cervical cancer. The virus is common in younger women, and their immune system usually gets rid of it.

Women 30 to 64

For women in this age group, most experts say:2, 1

  • You can have Pap and HPV tests every 5 years, if:
    • You had a normal Pap test.
    • You had a normal HPV test.
  • You can have a Pap test (without an HPV test) every 3 years.
Women 65 and older

Women ages 65 and older may no longer need Pap tests. Talk with your doctor about what's right for you.

Most experts say that you no longer need Pap tests if:2, 1

  • You've had 3 Pap tests in a row with normal results.
  • OR you've had 2 combined HPV and Pap tests in a row with normal results in the past 10 years and one of those tests was in the past 5 years.
Women who have had a hysterectomy

A hysterectomy is surgery to remove the uterus, usually including the cervix. Sometimes the cervix is not removed. You and your doctor can decide on the right screening based on your medical history.

  • Women without a cervix
    • You don't need Pap tests if your cervix was removed for reasons other than cancer.
    • You may have regular Pap tests if your cervix was removed for precancerous changes. But you may not need them as often if you have no other risk factors.2
    • You should have regular Pap tests if your cervix was removed for cervical cancer.
  • Women with a cervix
    • You should have regular Pap tests until age 65.

If you don't know if you still have your cervix, talk with your doctor.

What do your results mean?

Abnormal changes on your cervix may be minor or serious. Minor changes may go away on their own, especially if you are younger than 30.

If you have serious changes—which means the cells are the type that could turn into cancer—you may need more regular checkups and Pap tests. You may need treatment to remove the abnormal cells.

If you have a Pap test and an HPV test, your doctor will look at the results of both and decide what kind of follow-up tests you might need.

Experts agree that some women may need to be tested more often if they:

Women 21 to 29
  • If you had a Pap test and it was normal, you can wait 3 years to have another test.
  • If you had an abnormal Pap test result, your doctor will let you know if you need follow-up tests.
Women 30 to 64
Pap test and HPV test are both normal
  • The cells on your cervix look normal.
  • You don't have HPV.
  • You can wait 5 years to have another combined Pap and HPV test.
  • Your doctor will still want you to have physical exams. Ask how often you should come in.
Pap test is normal, but HPV is abnormal
  • The Pap test shows no abnormal changes to your cells.
  • The HPV test is positive, which means you have HPV.
  • Your body's immune system could get rid of HPV on its own.
  • You will likely have another Pap and HPV test in 1 year.
  • If you have one of the most high-risk types of HPV, your doctor may recommend a colposcopy. In this test, your doctor uses a lighted magnifying tool (colposcope) to get a closer look at the cervix.
Pap test is abnormal, but HPV test is normal
  • You have abnormal cell changes on your cervix.
  • You don't have HPV.
  • Your doctor may suggest a colposcopy to learn more about your abnormal cells.
Pap test and HPV are both abnormal
  • You have abnormal cell changes on your cervix.
  • You have HPV.
  • Your doctor will suggest a colposcopy.
  • Abnormal Pap and HPV test results don't mean that you have cervical cancer. But, depending on the type of cell changes, you will likely have treatment to remove the cells.
Pap test result isn't clear

Sometimes the results of the Pap aren't clear. There might not be enough cells to test. Or the cells may show very small changes that aren't certain. If this happens:

  • Your doctor will tell you when to have another Pap test—if you have a normal HPV test or if you didn't have an HPV test.
  • You may have a colposcopy if you are 30 or older and have a positive (abnormal) HPV test.

References

Citations

  1. U.S. Preventive Services Task Force (2012). Screening for cervical cancer: Summary of recommendations. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.
  2. American College of Obstetricians and Gynecologists (2012). Screening for cervical cancer. ACOG Practice Bulletin No. 131. Obstetrics and Gynecology, 120(5): 1222–1238.

Other Works Consulted

  • Centers for Disease Control and Prevention (2013). Cervical Cancer Screening With the HPV Test and the Pap Test in Women Ages 30 and Older. Accessed Sept. 17, 2013: http://www.cdc.gov/cancer/hpv/pdf/HPV_Testing_2012_English.pdf.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised November 1, 2013

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