Cervical cancer prevention

Cervical cancer is common among women worldwide. Screening can detect precursors and early-stage disease for both types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Treatment of precursors and early-stage disease can prevent the development of invasive cervical cancer and reduce cervical cancer mortality.

Cervical cancer screening began with the development of the Papanicolaou (Pap) test. With the Pap test screening, the incidence and mortality of cervical cancer have decreased. In addition to the Pap test, screening methods now include tests for high-risk strains of HPV (human papillomavirus). Infection with high-risk strains of HPV and persistence of HPV infection are the most important determinants of progression to cervical cancer

What is a pap test?

A Pap test (sometimes called a “Pap smear”) is a test that doctors use to check the cervix for early signs of cancer. The cervix is the bottom part of the uterus, where it meets the vagina.

To do a Pap test, your doctor or nurse will gently push apart the walls of your vagina using a device that looks like a duck beak. The device is called a “speculum.” Then, they will use a small tool to lightly scrape cells from the surface of your cervix. This might be a little uncomfortable, but usually will not hurt. The staff at a lab will look at the cells under a microscope to see if they are abnormal.

Do not assume that you are having a Pap test every time the doctor or nurse uses a speculum. That device is used for other reasons, too. If the doctor or nurses uses a speculum, ask whether you are being checked for cervical cancer.

Pap tests can find cancer cells or cells that could turn into cancer, called “precancer.” Precancer can be treated to try to prevent it from turning into cancer. The test can also usually find cancer in the early stages, when it can be treated or even cured.

When should a woman start having Pap tests?

Women should start having Pap tests when they turn 21. They do not need to be sexually active before they start getting Pap tests. When they turn 30, their doctors might also suggest doing another test to check for cervical cancer, called an HPV test. For this, the doctor or nurse takes cells from the cervix the same way they do for a Pap test.

What should I do to prepare for a Pap test?

You do not need to do anything special to prepare for a Pap test. Women sometimes hear that they should not have sex or put anything in their vagina for 2 days before a Pap test, but it turns out that is not necessary. Pap tests work fine even in women who have had sex recently or who have used vaginal lubricants or creams.

Do not worry if you have your period on the day of the test. The test can usually still be done even if you are bleeding. But if your bleeding is very heavy, you might want to call your doctor or nurse to see if you should reschedule.

How often should a woman have a Pap test?

That depends on how old she is and what the results of her past Pap tests have been.

  • Women age 21 to 29 should have a Pap test every 3 years.
  • Women age 30 and older can have a Pap test every 3 years or a Pap test and HPV test every 5 years.
  • Women age 65 and older should stop having Pap tests if they meet all of these requirements:
    • They have never smoked.
    • They do not have a new sex partner since their last Pap test.
    • They had Pap tests done regularly until they turned 65.
    • They had 3 normal Pap tests in a row.
    • They had no abnormal Pap tests in the past 10 years.
  • A woman might also get a Pap test if she has certain symptoms, such as vaginal bleeding.

Do I need to get Pap tests if I had a hysterectomy?

If you had surgery called a “hysterectomy” to remove your uterus, ask your doctor if you need to keep having Pap tests. If you no longer have a cervix, and if you did not have cervical cancer before your hysterectomy, you most likely do not need to have Pap testing after surgery.

What if I have an abnormal Pap test?

First, you should know that abnormal Pap tests are common. They are just an initial test, and most women with an abnormal Pap test do not have cancer. If your Pap test has cells that look “abnormal,” your doctor or nurse can follow up with another test to find out for sure what is going on.

Depending on your age and the result of your Pap test, your doctor or nurse might order an HPV test done on the sample they collected for the Pap test. The HPV test checks for infection with a type of HPV virus that can cause cancer.

Your doctor might also suggest that you have another follow-up Pap test or a test called a colposcopy. 

  • Another Pap test at 6 to 12 months – Sometimes a Pap test shows cells that could be either normal or abnormal. If you wait a few months and have another Pap test, you could find that the cells are back to normal. You might also need an HPV test at the same time.
  • A colposcopy – For this test, the doctor will use a speculum to look at your cervix, just like during a Pap test. But they will look more closely using a device that looks like a microscope. It allows the doctor or nurse to see the cervix in more detail. During this test, the doctor or nurse might also take tiny samples of tissue from the cervix. This is called a “biopsy.” Tissue from the biopsy can go to the lab and be checked for anything abnormal.

 

If it turns out that you have cervical cancer or precancer, there are effective treatments available. If your condition was found early, there is a good chance you can be cured.

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