Cervical cancer screening

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix

This page was reviewed on March 17, 2023.

Cervical cancer was once the leading cause of cancer deaths in women. As testing, screening and early detection have improved, the rate of new cervical cancer cases has been cut nearly in half since the early 1990s, according to the National Cancer Institute.

Many organizations have recently updated the cervical cancer screening guidelines and changed the ages at which women should consider getting screened.

This article will cover:

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Cervical cancer screening tests

Cervical cancer screening tests analyze samples of cells from the cervix. Two different tests are used to screen for cervical cancer, performed either separately or together.

These tests are designed to find changes that indicate an increased risk of cervical cancer before it develops. These changes may be an infection with the human papillomavirus (HPV) or changes to the cervical cells that show they may become cancerous.

Sometimes screening tests detect cancer that has already developed but is still in an early stage and easier to treat. If cervical cancer becomes symptomatic before it’s diagnosed, it’s often harder to treat. Regular screening may help find cervical cancer early.

The two tests used to screen for cervical cancer are:

The HPV test. This test uses a sample of cells from the cervix to test for infection with high-risk strains of HPV. HPV causes almost all cases of cervical cancer. This test will only tell whether there’s an HPV infection. It won’t tell whether the infection has caused precancerous changes to the cervical cells.

The Pap test, Pap smear, cervical cytology or Papanicolaou test. This test (known by many names) examines a sample of the cervical cells under a microscope to detect changes in their appearance. Cells in the smear are classified as abnormal precancerous or cancerous cells, normal cells or other growths. This screening test may also detect other changes to the cervix, including infections or inflammation.

Combined, these two screening tests are called an HPV/Pap co-test. This co-test tells the HPV status and whether any abnormal cervical cells were found. From the patient's point of view, there’s no difference in getting one test at a time or having both tests performed at the same time.

Cervical cancer screening guidelines

Cancer screening guidelines are recommendations doctors use to decide who should be tested for cancer and how often to test them. These guidelines are developed by many organizations, including:

  • U.S. Preventive Services Task Force (USPSTF)
  • American Congress of Obstetricians and Gynecologists (ACOG)
  • American Cancer Society (ACS)
  • American Society for Colposcopy and Cervical Pathology (ASCCP)
  • Society of Gynecologic Oncology (SGO)
  • Association of American Family Physicians (AAFP)
  • American Society of Clinical Oncology (ASCO)
  • Cancer Care Ontario (CCO)
  • World Health Organization (WHO)

City of Hope follows the guidelines from ACOG and SGO. Together, these guidelines recommend cervical cancer screening begin at age 21 for all women, regardless of sexual history and HPV vaccination status.

  • Between the ages of 21 and 29, women should have a Pap test every three years.
  • Women between the ages of 30 and 65 have three options:
    • Get a combination of a Pap test and an HPV test every five years.
    • Have a Pap test alone every 3 years.
    • Have an HPV test alone every five years.
  • Women over age 65 may stop screening if they have had adequate prior screenings and are not at high risk for cervical cancer.

Should everyone have cervical cancer screening?

Not everyone needs cervical cancer screening.

Cervical cancer guidelines don’t apply to those who have already been diagnosed with cervical cancer or cervical precancer, or women with a suppressed immune system.

The guidelines don’t recommend screening for:

  • Women who still have their cervix, are over 65 and who have had normal screening results for more than 10 years
  • Women who have had their cervix removed, unless the surgery was to treat cervical cancer or precancer.

What is cervical precancer?

An abnormal Pap smear may find cervical precancer cells that are infected with HPV and have undergone changes that make them abnormal. When HPV causes abnormal cells in the cervix, it’s called cervical dysplasia.

If a Pap test detects cervical dysplasia, the disease may be classified as a precancer, but this doesn’t mean it’ll develop into cancer. Low-grade dysplasia may go away on its own, and often doctors will just monitor it over time. It’s typically not treated unless it persists for a couple of years. High-grade cervical dysplasia may require a biopsy to determine the next steps.

A precancerous condition like cervical dysplasia isn’t cancer. It simply means the patient has an increased risk of cancer. It should serve as a reminder for the patient to stay up to date on her medical visits and screening tests. Patients should make a note of any changes in symptoms and talk to a health care provider about any questions or concerns.

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