Cervical Cancer Screening

Topic Overview

What is screening for cervical cancer?

Cervical cancer screening tests can help your doctor find and treat abnormal cell changes on your cervix before they develop into cervical cancer. These tests may be done as part of a pelvic exam.

What screening tests are used?

Tests include:

• A Pap test. This test looks for changes in the cells of the cervix. Abnormal cells may be a sign of cancer.
• An HPV test. There are many types of HPV, and some of them can cause cancer. The HPV test may be used with the Pap test in women ages 30 and older. Having both a Pap test and an HPV test is called co-testing.

There is also a test called a primary HPV test. This is a newer test for women ages 25 and older. A woman who has this test doesn't need to have a Pap test.

Who should be screened?

Experts, such as the U.S Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG), agree that women should begin screening at age 21 and continue until they are age 65. Women who have had a hysterectomy and no longer have a cervix don't need to have tests (unless a woman had the hysterectomy because of cervical cancer).

If you are younger than 21 and are sexually active, it's still a good idea to have regular testing for sexually transmitted infections.

How often do you need tests for cervical cancer?

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.

Women 21 to 29

You start having Pap tests at age 21. Women younger than 21 shouldn't be screened, except for women who are infected with human immunodeficiency virus (HIV).

• You have a Pap test every 3 years. Testing should not be done every year.

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. The exception is the newer test called the primary HPV test, which can be started at age 25, and redone every 3 years.

Women 30 to 64

For women in this age group, most experts say:

• 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, for as long as your results are normal.

The ACOG guideline includes information on the newer primary HPV test for women ages 25 to 64.^{footnote 1} With a normal result from the primary HPV test, a woman can continue to be screened every 3 years. Screening should stop at age 65 for a woman with a normal screening history. A woman who no longer has a cervix shouldn't have a primary HPV test.

Women 65 and older

Women ages 65 and older may no longer need to be screened for cervical cancer. Talk with your doctor about what's right for you.

Most experts say that after you turn age 65, you no longer need screening tests if:

• 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.
  • 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:

• Were exposed to DES (diethylstilbestrol) before birth (prenatal exposure).
• Have HIV (human immunodeficiency virus).
• Have a history of abnormal Pap tests or cervical cancer.
• Have a weakened immune system.

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.
• If you had a primary HPV test and your result was normal, you can wait 3 years to have another test.
• If you had an abnormal primary HPV test result, your doctor will tell you 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.

Primary HPV test is abnormal

• Your primary HPV test is positive, which means you have HPV.
• Your doctor will tell you what follow-up tests you will need. If the follow-up test results are normal, then you will likely need another screening test in 1 year.
• If you have one of the most high-risk types of HPV, your doctor may recommend a colposcopy (and possibly a biopsy).