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Cervical Cancer Screening (Pap Test)

A Pap test (sometimes called a Pap smear) is a screening tool used to help find cell changes that, if left untreated, may lead to cervical cancer. Cervical cancer is cancer of the cervix, the narrow part of the uterus that opens into the vagina.

What Happens During a Pap Test

A Pap test is simple, quick, and usually only slightly uncomfortable. During the test, your doctor takes a sample of cells from your cervix.

To do this, your doctor uses an instrument called a speculum to keep the walls of the vagina apart in order to see your cervix. Your doctor then takes some cells from the cervix using a small spatula and a small brush. During the test, you may feel some light pressure or mild discomfort.

The doctor sends the cell sample to the lab, where it is examined under a microscope to see if the cells look normal.

How to Prepare for a Pap Test

Don't douche, have sex, or put anything in your vagina for at least 24 hours before the test. When you come in for the Pap test, your doctor might ask you for the date of your last period, if you are taking any hormones, or what type of birth control you use. Tell your doctor if you've had surgery on your cervix or if you've had a hysterectomy.

When to Get a Pap Test

Group Health recommends that most women between 21 and 65 years of age — who still have a uterus and have ever been sexually active, with either a man or another woman — get a Pap test on a regular schedule.

Sexual activity can expose women to many sexually transmitted infections (also called sexually transmitted diseases) including human papillomavirus (HPV). HPV can cause abnormal cell growth which, in some cases, can lead to cervical cancer.

Starting at age 21, we recommend a Pap test every three years up until age 30. Beginning at age 30, women should get a Pap test every three or five years, depending on risk. Most women will not need to continue to get Pap tests after age 65.

Even if you've had only one sexual experience, and even if it was years ago, you should have Pap tests regularly. Continue to have Pap tests until age 65, even after you're no longer sexually active.

Getting a Pap test every three or five years is safe for most women. It can take a long time for cell changes to develop into cancer. Either schedule gives your doctor a chance to find and treat changes in the cells of your cervix that could lead to cancer. Finding changes early is the key to preventing cancer.

Some women should have a Pap test more often. Ask your doctor about a schedule that's best for you if you have, or have had, any of the following:

• A biopsy that showed CIN (cervical intraepithelial neoplasia). CIN is a type of abnormal cell change on the cervix.
• An HIV-positive test or are immunosuppressed. For example, you've had an organ transplant or you're taking drugs that suppress your immune system.
• Exposure to DES (diethylstilbesterol) when your mother was pregnant with you. DES is a medicine once prescribed to prevent miscarriage and premature delivery. This medicine is no longer used.

Some women don't need Pap tests. You might not need routine Pap tests if you:

• Are 65 or older, your last Pap test was done within the last three to five years, and it was normal.
• Have had a hysterectomy with removal of the cervix for noncancerous reasons and have no history of CIN.
• Have never been sexually active. However, once you become sexually active, and you are over age 21, you should begin to have regular Pap tests.

About HPV

There are two types of HPV: low-risk and high-risk. Both types of HPV can cause abnormal cell changes on the cervix. If left untreated, the changes caused by some types of high-risk HPV can develop into cervical cancer.

An HPV vaccine is available to protect against diseases caused by the specific genital human papillomaviruses (HPV) contained in the vaccine. Please talk to your doctor if you're interested.

See Genital HPV: What You Need to Know

Abnormal Pap Tests

There are many different causes for abnormal results, and only a small percentage of women with abnormal Pap test results have changes that might progress to cancer.

If changes are found, your doctor might do additional tests. These tests include testing your original Pap sample for HPV, asking you to come back for another Pap test, or having a colposcopy.

Colposcopy is an exam of the cervix. It is similar to a Pap test. An instrument called a colposcope magnifies the cervix so your doctor can take a closer look. Your doctor might remove a small tissue sample (biopsy). The tissue is examined under a microscope to look for precancerous changes.

If precancerous changes are found, there are several treatment options that can usually be done in your doctor's office.

Lower Your Risk for Cervical Cancer

• Come in regularly for your Pap tests. Finding and treating cell changes in the cervix early is key to preventing cancer.
• Don't smoke. Smoking can weaken the immune system, making it hard to clear genital HPV from your body. This puts you at greater risk for developing cervical cancer. If you smoke, ask your doctor for information about tobacco cessation programs. Or contact the Quit for LifeŽ Program.

If You Have Symptoms But It Isn't Time for a Pap Test

Some symptoms should be checked right away. If you have any of the following symptoms, or other symptoms that concern you, talk to your doctor even if it isn't time for your Pap test.

• Bleeding between periods
• Bleeding or pain after having intercourse
• Any vaginal bleeding if you have gone through menopause, even if you are using hormone therapy
• Abnormal vaginal discharge
• Pelvic pain
• Persistent itching or irritation on the outside or opening of the vagina

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