Cervical Cancer Screenings

Understanding the types of cervical cancer screenings is essential for every woman. These tests are designed to help prevent cervical cancer or detect it early:

• Pap test (Pap smear): This involves collecting cervical cells to check for changes that could lead to cervical cancer. This test can detect both precancerous cells and cervical cancer cells. It may also identify non-cancerous conditions, such as infections or inflammation.
• Human papillomavirus (HPV) test: This test examines cells for infections with high-risk HPV types known to cause cervical cancer.
  
• HPV/pap cotest: A combination of the HPV test and the Pap test, this method screens for high-risk HPV and checks for cervical cell changes simultaneously.

Cervical cancer screening tests are done during a pelvic exam by placing a speculum in the vagina to visualize the cervix. Cells and mucus from the cervix are collected with a brush or spatula and sent to the lab for evaluation. 

It is important to know that a pelvic exam is not the same as a pap test. A pap test can be collected during a pelvic exam, but many times a pelvic exam is done without a pap test.

Screening varies depending on a woman’s age and risk factors:

• Ages 21-29: The first pap test is recommended at age 21, with subsequent pap tests every 3 years.
  
• Ages 30-65: Various options include the HPV test every 5 years, HPV/pap cotest every 5 years or a pap test every 3 years.
  
• Ages 65 and Older: Screening may not be necessary for individuals who have consistently received normal test results for several years. Those with recent abnormal results or a history of irregular screenings may need to continue screenings beyond age 65.

Generally, the American Cancer Society recommends that you should screen for cervical cancer every 3-5 years. Certain conditions or medical histories may require more frequent screening, including:

• Being HIV positive
• Having a compromised immune system
• Exposure to diethylstilbestrol (DES) before birth
• Previous abnormal cervical screening or biopsy results
• A history of cervical cancer

While cervical cancer screening has numerous benefits, there are also potential risks:

• Abnormal results can lead to more frequent testing and invasive diagnostic procedures, such as colposcopies and cervical biopsies.
• Diagnostic procedures can cause vaginal bleeding, pain, infection or failure to diagnose a condition due to inadequate sampling.
• Abnormal results are also associated with anxiety, distress and an increased concern about health status.

It is important to follow recommended screening guidelines and make a shared decision with your provider regarding the frequency of your cervical cancer screenings based on your individual conditions.

To ensure the most accurate results, don’t insert anything in the vagina or have intercourse for 2-3 days prior to your pap test. This includes tampons, medications, creams, moisturizers, lubricants, birth control/spermicide foams or jellies or douches. If possible, try to schedule your appointment at least 5 days after your menstrual period. 

Depending on the results and your history, you may need additional testing:

• A colposcopy is an exam using an instrument with magnifying lenses to examine the cervix more closely and clearly for changes.
• A cervical biopsy is a tissue sample which may be taken during the colposcopy exam.
• An endocervical curettage is another type of cervical tissue sample which is collected when a narrow instrument or brush is inserted into the endocervical canal and some of the tissue is scraped.
• A LEEP (loop electrosurgical excision procedure) cone biopsy is a procedure to remove cervical tissue using a thin heated wire. This is used to diagnose and treat pre-cancer and early-stage cancer. This can be done in the operating room or office setting.
• A cold knife cone biopsy is a procedure to remove cervical tissue using a scalpel or laser. Anesthesia is required and therefore it needs to be done in the OR.