In the United States, cervical cancer is the fifth most common cancer among women aged 35-54, and the third most common cancer of the female reproductive tract. In some developing countries, it is the most common type of cancer. The cervix is the lower part of the uterus, the place where a baby grows during pregnancy.
Cervical cancer begins when healthy cells on the surface of the cervix change or get infected with human papillomavirus (HPV) and grow out of control, forming a mass called a tumor. Long-term infection of HPV on the cervix can result in cancer, leading to a mass or tumor on the cervix. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.
Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat.
Cervical cancer screening is usually part of a woman's health checkup. There are two types of tests: the Pap test and the HPV test. A Pap test is the most common test used to look for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. For both, the doctor or nurse collects cells from the surface of the cervix. With the Pap test, the lab checks the sample for cancer cells or abnormal cells that could become cancer later. With the HPV test, the lab checks for HPV infection. HPV is a virus that spreads through sexual contact. It can sometimes lead to cancer. If your screening tests are abnormal, your doctor may do more tests, such as a biopsy.
Cervical cancer screening has risks. The results can sometimes be wrong, and you may have unnecessary follow-up tests. There are also benefits. Screening has been shown to decrease the number of deaths from cervical cancer. You and your doctor should discuss your risk for cervical cancer, the pros and cons of the screening tests, at what age to start being screened, and how often to be screened.
Who performs my Pap test?
A gynecologist typically performs a Pap test. A gynecologist is a medical doctor who specializes in treating diseases of a woman’s reproductive organs. Sometimes other health care providers perform Pap tests. This may include primary care doctors, physician assistants, or nurse practitioners. If the person performing the test is a man, a female assistant or nurse may also be in the room.
If the results of the Pap test show cervical cancer, your health care provider will refer you to a gynecologist or an oncologist. An oncologist is a doctor who specializes in treating cancer.
How should I prepare for a Pap test?
To ensure that the Pap test results are as accurate as possible, do not have sexual intercourse for 2 to 3 days before the test. Also, to avoid washing away abnormal cells, do not use the following for 2 to 3 days before the test:
- Birth control foams
- Vaginal medicines
- Vaginal creams or powders
The best time to schedule your Pap test is at least 5 days after the end of your menstrual period. A Pap test can be done during your menstrual period, but it is better to schedule the test at another time.
During the Pap test
Your health care provider will perform the Pap test during a pelvic exam in a private room in his or her office. It takes only a few minutes. The test may be uncomfortable, but it is not usually painful. You may experience less discomfort if you empty your bladder before the examination. Also, try taking deep breaths and relaxing your muscles during the procedure.
When you arrive for your Pap test, your health care provider may ask you some basic questions related to the test. These may include:
- Are you pregnant?
- Do you use birth control?
- What medications have you taken recently?
- Do you smoke?
- When was your last menstrual period, and how long did it last?
- Do you have any symptoms, such as itching, redness, or sores?
- Have you had surgery or other procedures on your reproductive organs?
- Have you ever had abnormal results from a previous Pap test?
Before the procedure, you may need to change into a hospital gown in a private area or when your health care provider leaves the room. During the procedure, you will lay on your back on the exam table with your heels in the stirrups at the end of the table.
Next, your health care provider performing the exam will gently insert a lubricated plastic or metal instrument into your vagina. This tool, called a speculum, slowly spreads apart the vaginal walls. It may cause some discomfort.
After a visual inspection of your cervix, your health care provider will use a cotton swab or a cervical brush to gently scrape cells from 2 places on the cervix:
- The ectocervix, which is the part closest to the vagina
- The endocervix, which is the part next to the body of the uterus. This area is called the transformation zone, and it is the location where cervical cancer typically develops.
You may feel pulling or pressure during the collection of the cells, but it typically does not hurt.
Your health care provider will smear the cells onto a glass microscope slide or put the cells into a container with liquid that preserves the sample. He or she will then send the sample to a pathologist for evaluation.
After a Pap test
You can resume your normal activities right after having a Pap test. You may have a small amount of vaginal bleeding after your Pap test. But tell your health care provider if you experience excessive bleeding.
If the Pap test shows abnormal cells and an HPV test is positive, your health care provider may suggest one or more additional tests. The Pap test is an excellent screening tool, but it is not perfect. Sometimes the results are normal even when abnormal cervical cells are present. This is called a "false negative" test result.
Regular screening is important. Talk with your health care provider about how often you should have a Pap test. Research shows that almost all cervical changes can be found with regular screening and treated before they become cancerous.