Cervical Cancer: Screening and Prevention

Screening

The two screening tests for cervical dysplasia are the Pap test (also known as the Pap smear) and HPV test. The Pap smear is performed during a pelvic exam.

A pelvic exam is an internal exam of the female reproductive tract and surrounding organs. This includes the uterus, cervix, vagina, ovaries, fallopian tubes, bladder and rectum. The first step is for you to lie down on an examination table and put your feet in stirrups. Next, an instrument called a speculum is inserted into your vagina to hold your vaginal walls open so your healthcare provider can view the inside of the vaginal walls and the cervix, and collect a sample of cervical tissue for your Pap test.

Once the speculum is inserted into the vagina, and the cervix is visible to the healthcare provider, the Pap test is performed by using a plastic spatula to gently scrape the surface of the cervix. This action collects cells from the surface of the cervix. A small brush is then inserted into the cervical canal in order to collect cells from the inside of the cervix. These cells are then collected in a special fluid that allows the cells to be evaluated under a microscope to tell if there are any abnormal changes, or cervical dysplasia. Getting a Pap test only takes a few minutes and is usually not painful. The same sample of cells in the special fluid can be used to test for HPV.

Screening recommendations depends on your age. The American Cancer Society and the American Society for Cervical Cytology and Pathology recommend starting cervical cancer screening at age 21, regardless of the age when a woman becomes sexually active. Women who are less than 21 years old should not get cervical cancer screening with a Pap test or and HPV test.

Women aged 21 to 29 years should be screened for cervical cancer with a Pap test every 3 years if their prior Pap tests have been normal. For some women, an HPV test may be done in order to guide management of certain abnormal Pap test results.

Women aged 30 – 65 years should be screened for cervical cancer with both a Pap test and an HPV test. When the Pap and HPV test are automatically done together, this is called co-testing. Co-testing is recommended every 5 years if both the Pap and the HPV test are normal. Women need to continue to get screened for cervical cancer regardless of whether or not they are sexually active.

Women older than 65 years do not need cervical cancer screening if all of their recent cervical cancer screening tests have been normal. Women with a history of cervical pre-cancer need to continue to get screening for 20 years after they were treated for the pre-cancer. Women who have had a hysterectomy (who no longer have a cervix) and who do not have a history of cervical pre-cancer do not need cervical cancer screening (they do not need to get Pap tests or HPV tests).

 

Prevention

Cervical cancer can be prevented by having regular cancer screening between the ages of 21 and 65, and by getting the HPV vaccine. The HPV vaccine is safe. It is effective in protecting against the most common high risk strains of HPV that cause cervical cancer. The Advisory Committee on Immunization Practices (ACIP) recommends that all girls and boys get the HPV vaccine at age 11 or 12 years, although vaccination start as early as 9 years. The HPV vaccine is also recommended for females through age 26 and for males through age 21 who were not vaccinated previously. Males may also be vaccinated through age 26.