Cervical cancer is a cancer that affects the cells that line the inside of the cervix (the lower part of the uterus). There may be some other causes, but it is most often caused by the human papillomavirus (HPV).
Cervical cancer is the most common cancer in women in the United States, and the fourth most common cancer in women worldwide. It is also the second most common cause of cancer death in women. Cervical cancer is usually diagnosed when it has already begun to grow in the cervix.
What is cervix?
The cervix is the bottom part of the uterus, where it meets the vagina.
What is cervical cancer screening?
Screening tests look for cancer cells in the cervix. Screening tests also look for cells that could turn into cancer, called “pre-cancer cells.” They can find cervical cancer and pre-cancer in the early stages, when it can be treated or even cured.
How the screening of cervical cancer done?
There are various methods to screen. These include:
Pap test – This is also known as “Pap smear.” It involves taking cells from the surface of the cervix and the cells are then checked under the microscope by an expert.
Human papillomavirus or HPV test – Some strains of this virus can cause cervical cancer. An HPV test involves testing cells from the cervix for these types of HPV.
Combination test – Both Pap smear and HPV test are done at the same time.
How Pap or HPV test is done?
For both tests, the doctor will take cells from the surface of cervix. To do this, they will gently insert a device called a “speculum” into vagina. The device helps to push apart the walls of vagina so that the cervix becomes visible. Then, they will use a small tool to lightly scrape cells from the surface of cervix. The tool looks like a small spatula or brush. This might be a little uncomfortable, but usually does not hurt.
When is the cervical cancer screening needs to be done?
In US, most experts recommend that you start having Pap tests when you turn 21. Some experts recommend HPV tests instead of Pap tests, starting at age 25. But this option might not be available in many places. But different regions have different recommendations, so you shall consult your doctor.
Is there any special preparation for a Pap or HPV test?
There isn’t anything special to prepare. Recent sexual intercourse or menstruation does not affect the test; however it is still better to schedule when there is no bleeding.
How often cervical cancer screening is recommended?
This depends on the age and the results of past tests.
If the age is 21 to 29, Pap test shall be done every 3 years. Or, if the doctor recommends HPV testing instead, a test is done every 5 years beginning at age 25.
If the age is 30 or older, have a Pap test every 3 years. The other options are having an HPV test every 5 years, or a combination Pap and HPV test every 5 years.
If age is 65 or older, stop having Pap tests if:
- You had Pap tests done regularly until you turned 65.
- You had 3 normal Pap tests in a row, or 2 normal combination Pap and HPV tests over the past 10 years (if the most recent test was within the past 5 years).
- You do not have other medical conditions that could weaken your immune system – These include taking certain medicines or having HIV.
Is the PAP test done only for screening the cervical cancer?
Pap test is also done for reasons other than cervical cancer screening. For example, if there is abnormal vaginal bleeding, the doctor might do a Pap test to try to figure out the cause.
Shall screening for cervical cancer be done in those who had a hysterectomy (hysterectomy = the uterus is removed by surgery)?
After a hysterectomy, probably there is no need of screening if:
- The cervix was also removed along with your uterus, and
- The person did not have cervical cancer or precancer (precancer is also called “dysplasia” in medical term).
If not sure, seek help of your doctor to figure out if you need to continue screening.
Is screening needed if someone has taken the HPV vaccine?
Yes. Getting the HPV vaccine lowers the chances of getting an HPV infection that could lead to cervical cancer. But it does not completely protect from it and screening shall be continued for cancer or precancer.
What if Pap test result turn out as abnormal?
Abnormal Pap tests are common, and most people with an abnormal Pap test do not have cancer. If your Pap test has cells that look abnormal, the doctor can do more tests to figure out what is causing this. They will decide what to do based on your age, what your Pap test shows, and the results of any other tests you had.
Follow-up tests might include:
HPV test – If you haven’t already had an HPV test, your doctor might order one. They might be able to do this on the cells already taken during your Pap test.
Another Pap test in 12 months – Sometimes, if you wait a year and have another Pap test, you could find that the abnormal cells are back to normal. You might also have an HPV test at the same time.
Colposcopy – During this this test, the doctor will use a speculum to look at 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 to see the cervix in more detail. During this test, the doctor might also take tiny samples of tissue from the cervix. This is called a “biopsy.” The tissue samples are checked in a lab.
If you do have cervical cancer or precancer, there are effective treatments available. If your condition was found early, there is a good chance that you can be cured.
What if HPV test comes back positive?
Most people who have sexual intercourse will be exposed to HPV at some point, and having HPV does not mean that they will definitely get cancer. For most people, HPV infection goes away on its own. But for some people, it does not. Long-lasting HPV infection increases the risk of cancer over time.
If HPV test comes back positive, the doctor will explain what to do. This will partly depend on whether the Pap test results were also abnormal. If the HPV test is positive but Pap test is normal, they might advise to repeat the tests in 1 year so to see if anything has changed.