What is the importance of cervical cancer screening. How often should women get tested. What do Pap smears and HPV tests detect. When should screening begin and end. How are these tests performed.

The Importance of Cervical Cancer Screening

Cervical cancer screening plays a crucial role in women’s health by detecting abnormal cell changes in the cervix before they develop into cancer. Regular screening can prevent cervical cancer or catch it at an early, highly treatable stage.

There are two main types of cervical cancer screening tests:

• Pap test (Pap smear): Examines cervical cells for precancerous changes
• HPV test: Checks for the human papillomavirus that can cause cervical cell changes

These tests can be performed separately or together, depending on a woman’s age and risk factors. Understanding the importance of these screenings and following recommended guidelines can significantly reduce the risk of developing cervical cancer.

When to Start Cervical Cancer Screening

Knowing when to begin cervical cancer screening is essential for maintaining optimal reproductive health. Current guidelines recommend:

• Women should start getting Pap tests at age 21
• If the initial Pap test result is normal, screening can be repeated every three years

Is there a reason to start screening earlier than 21? In most cases, no. The risk of cervical cancer in women under 21 is extremely low, and unnecessary screening can lead to anxiety and potentially harmful overtreatment.

Screening Recommendations for Women 30-65

As women age, the screening recommendations change to reflect their evolving risk profile. For women between 30 and 65 years old, there are several options:

1. HPV test only (primary HPV testing) every 5 years
2. HPV test combined with a Pap test (co-testing) every 5 years
3. Pap test alone every 3 years

Which option is best? The choice depends on individual risk factors and preferences. Discussing these options with a healthcare provider can help determine the most appropriate screening strategy.

The Procedure: What to Expect During a Pap Smear or HPV Test

Understanding the procedure can help alleviate anxiety and ensure a more comfortable experience. Here’s what typically happens during a Pap smear or HPV test:

• The patient lies on an exam table with feet in stirrups
• A speculum is inserted into the vagina to provide a clear view of the cervix
• For a Pap test, cells are gently scraped from the cervix using a small brush or spatula
• For an HPV test, a small brush is used to collect cells from the cervix
• The collected cells are sent to a laboratory for analysis

Do these tests hurt? Most women experience only mild discomfort during the procedure, which typically lasts just a few minutes.

Preparing for Your Screening

To ensure accurate results, it’s important to prepare properly for your cervical cancer screening:

• Avoid intercourse, douching, and using vaginal medicines or spermicidal foam for 2 days before the test
• If you’re menstruating, consider rescheduling unless advised otherwise by your doctor
• Inform your healthcare provider if you’ve had sex within 24 hours of the test

Understanding Your Test Results

Receiving test results can be anxiety-inducing, but understanding what they mean is crucial. Here’s a breakdown of potential outcomes:

• Normal results: Indicate no abnormal cell changes were detected
• Abnormal results: May suggest the presence of precancerous cells or HPV infection

How long does it take to get results? It typically takes up to three weeks to receive your test results. If the results are abnormal, your healthcare provider will contact you to discuss next steps.

Are abnormal results always indicative of cancer? No, abnormal results don’t necessarily mean you have cancer. Many abnormalities are minor and may resolve on their own. However, follow-up testing or treatment may be necessary to prevent the development of cervical cancer.

Cervical Cancer Screening for Women Over 65

As women age, the need for cervical cancer screening may change. For those over 65, screening recommendations depend on previous test results and individual risk factors.

Can women over 65 stop getting screened? Screening may be discontinued if:

• You’ve had consistently normal results for several years
• You haven’t had a cervical precancer in the past
• Your cervix has been removed as part of a total hysterectomy for non-cancerous conditions

However, it’s crucial to consult with a healthcare provider before discontinuing screening, as individual circumstances may warrant continued testing.

The Role of HPV in Cervical Cancer

Understanding the connection between HPV and cervical cancer is essential for comprehending the importance of screening. Human papillomavirus (HPV) is a common sexually transmitted infection that plays a significant role in the development of cervical cancer.

How does HPV cause cervical cancer? Most HPV infections clear on their own, but persistent infections with high-risk HPV types can lead to cellular changes that may progress to cancer over time. This is why HPV testing is an important component of cervical cancer screening.

HPV Vaccination

HPV vaccination is a powerful tool in preventing cervical cancer. The vaccine protects against the most common high-risk HPV types associated with cervical cancer.

Who should get the HPV vaccine? The CDC recommends HPV vaccination for:

• All preteens (including boys) at age 11 or 12
• Everyone through age 26, if not vaccinated already
• Some adults age 27 through 45 who are not already vaccinated and are at risk for new HPV infections

Does getting vaccinated mean you don’t need screening? No, vaccinated individuals should still follow recommended screening guidelines, as the vaccine doesn’t protect against all HPV types that can cause cervical cancer.

Managing Abnormal Test Results

Receiving abnormal test results can be concerning, but it’s important to remember that many abnormalities do not progress to cancer. Here’s what you need to know about managing abnormal results:

Follow-up Procedures

Depending on the severity of the abnormality, your healthcare provider may recommend:

• Repeat testing in 6-12 months
• Colposcopy: A procedure that allows for closer examination of the cervix
• Biopsy: Removal of a small tissue sample for further analysis

What is the goal of these follow-up procedures? The primary aim is to determine the extent of the abnormality and whether treatment is necessary to prevent the development of cervical cancer.

Treatment Options

If precancerous cells are detected, several treatment options are available:

• LEEP (Loop Electrosurgical Excision Procedure): Removes abnormal tissue using a thin wire loop
• Cryotherapy: Freezes and destroys abnormal cells
• Laser therapy: Uses a laser beam to remove abnormal tissue
• Conization: Surgically removes a cone-shaped piece of tissue containing the abnormal cells

How effective are these treatments? When performed by experienced healthcare providers, these procedures are highly effective at removing precancerous cells and preventing the progression to cervical cancer.

Overcoming Barriers to Cervical Cancer Screening

Despite the importance of cervical cancer screening, many women face barriers that prevent them from getting tested regularly. Addressing these obstacles is crucial for improving screening rates and reducing cervical cancer incidence.

Common Barriers

Some of the most frequent barriers to cervical cancer screening include:

• Lack of health insurance or financial resources
• Limited access to healthcare facilities
• Cultural or language barriers
• Fear or embarrassment about the procedure
• Lack of awareness about the importance of screening

Overcoming Obstacles

Several strategies can help overcome these barriers:

• Education and awareness campaigns about the importance of screening
• Providing culturally sensitive and language-appropriate information
• Offering mobile screening units to reach underserved areas
• Implementing patient navigation programs to guide women through the screening process
• Utilizing community health workers to promote screening and address concerns

Are there programs to help women without insurance get screened? Yes, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free or low-cost screening services to eligible women.

The Future of Cervical Cancer Screening

As medical technology advances, the landscape of cervical cancer screening continues to evolve. Understanding these developments can provide insight into future screening methods and strategies.

Emerging Technologies

Several promising technologies are being developed or refined:

• HPV self-sampling: Allows women to collect their own samples at home
• AI-assisted cytology: Uses artificial intelligence to improve the accuracy of Pap smear analysis
• Biomarker testing: Identifies specific molecular markers associated with cervical cancer risk

How might these technologies change cervical cancer screening? These advancements could potentially make screening more accessible, accurate, and personalized, further reducing cervical cancer rates.

Personalized Screening Approaches

The future of cervical cancer screening may involve more tailored approaches based on individual risk factors:

• Genetic testing to identify high-risk individuals
• Risk-based screening intervals that consider personal and family history
• Integration of multiple screening modalities for comprehensive risk assessment

Will these personalized approaches replace current screening guidelines? While personalized screening shows promise, it’s likely to complement rather than replace current guidelines in the near future. Ongoing research will help determine the most effective strategies for different populations.

The Impact of Regular Screening on Cervical Cancer Rates

Regular cervical cancer screening has had a profound impact on reducing cervical cancer incidence and mortality rates. Understanding this impact underscores the importance of adhering to screening guidelines.

Statistical Trends

Since the widespread adoption of Pap smear screening:

• Cervical cancer incidence rates have decreased by more than 60% in many developed countries
• Mortality rates have declined by similar margins
• The majority of cervical cancers are now diagnosed in women who have not been screened or have been screened irregularly

What do these trends indicate? They demonstrate that regular screening is highly effective in preventing cervical cancer and catching it at early, treatable stages.

Global Disparities

Despite the success in many countries, significant disparities exist globally:

• Cervical cancer remains a leading cause of cancer death for women in many low- and middle-income countries
• Limited access to screening and HPV vaccination contributes to higher incidence and mortality rates in these regions

How can these disparities be addressed? Efforts to improve global access to screening and vaccination, along with education and awareness campaigns, are crucial for reducing cervical cancer rates worldwide.

Empowering Women Through Knowledge and Action

Empowering women with knowledge about cervical cancer screening is crucial for improving health outcomes. By understanding the importance of regular screening, the available testing options, and how to interpret results, women can take an active role in protecting their health.

Taking Control of Your Health

Here are some key steps women can take to prioritize their cervical health:

• Schedule regular screenings according to recommended guidelines
• Stay informed about changes in screening recommendations
• Discuss any concerns or questions with healthcare providers
• Encourage friends and family members to get screened
• Consider HPV vaccination if eligible

How can women stay motivated to maintain regular screening? Understanding the potential life-saving benefits of early detection and viewing screening as an act of self-care can help women prioritize their cervical health.

Advocating for Better Access and Awareness

Women can also play a role in improving cervical cancer prevention on a broader scale:

• Support initiatives that promote access to screening and vaccination
• Share accurate information about cervical cancer prevention within communities
• Participate in awareness campaigns and events
• Advocate for policies that support women’s health and cancer prevention

Can individual actions make a difference in the fight against cervical cancer? Absolutely. By taking control of their own health and advocating for others, women can contribute to the ongoing efforts to reduce cervical cancer rates and save lives.

What Should I Know About Cervical Cancer Screening?

Español (Spanish) | Print

“If I didn’t go to that appointment, I might not be around for my kids,” says Cindy. Her cervical cancer screening test found precancerous cells. She shares her story in this video.

The HPV test and the Pap test can help prevent cervical cancer or find it early.

• The HPV test looks for the virus (human papillomavirus) that can cause cell changes on the cervix.
• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

Both tests can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to look inside your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are sent to a laboratory.

• If you are getting a Pap test, the cells will be checked to see if they look normal.
• If you are getting an HPV test, the cells will be tested for HPV.

What is cervical precancer? When there are cervical cells that look abnormal but are not yet cancerous, it is called cervical precancer. These abnormal cells may be the first sign of cancer that develops years later. Cervical precancer usually doesn’t cause pain or other symptoms. It is found with a pelvic exam or a Pap test.

If you have a low income or do not have health insurance, you may be able to get a free or low-cost screening test through the National Breast and Cervical Cancer Early Detection Program.

Find out if you qualify

When to Get Screened

If You Are 21 to 29 Years Old

You should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If You Are 30 to 65 Years Old

Talk to your doctor about which testing option is right for you—

• An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
• An HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.
• A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If You Are Older Than 65

Your doctor may tell you that you don’t need to be screened anymore if—

• You have had normal screening test results for several years, and
• You have not had a cervical precancer in the past, or
• You have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

No special preparation is needed before you have an HPV test.

If you are getting a Pap test, you can take steps to make sure the test results are accurate. Avoid intercourse, douching, and using vaginal medicines or spermicidal foam for 2 days before the test. If you had sex before the test, go to the appointment as planned and let the doctor know.

If you have your period, don’t worry. Both tests can still be done at this time.

Test Results

It can take as long as three weeks to receive your test results. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why test results might not be normal. It usually does not mean you have cancer.

If your test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may tell you that you can wait several years for your next cervical cancer screening test. But you should still go to the doctor regularly for a checkup.

Can A Pap Smear Detect Early Cervical Cancer?

Dr. Priti Ranjan | 12/27/2021

If you’re like many women, you may put the needs of your friends and family before your own. When it comes to your health, however, it’s critical that you make time to visit your primary care physician at least once per year for a well-woman exam and other tests, including a Pap smear. At Nest Family Medicine in Plano, TX, board-certified family physician Dr. Priti Ranjan provides comprehensive, compassionate, and customized care for each patient to both restore and preserve their health at every stage of life. Keep reading for a closer look at why a Pap smear should be performed every year, what information can be learned through a Pap smear, and whether a Pap smear can identify early cervical cancer.

Why do I need a Pap smear?

The Pap smear, also called a Pap test, is an essential part of a woman’s regular healthcare routine. Based on your personal health history, family history, and other factors, Dr. Ranjan will recommend the most appropriate frequency for your Pap smears, though they are typically performed annually during a well-woman exam. The Pap smear is primarily used to detect abnormal cells in the cervix, which can point to precancerous changes or even the possibility of cervical cancer being present. By detecting abnormal cervical cells early, the potential for effective treatment of cervical cancer – and even a full cure – is dramatically higher.

What does it mean if my Pap smear is positive?

Finding out that your Pap smear returned positive can understandably be frightening, but try not to panic. In the majority of cases, a positive Pap smear does not mean a patient has cervical cancer. Instead, a positive Pap test can indicate the presence of abnormal cells, which are often caused by exposure to HPV. However, the Pap smear alone cannot diagnose the condition that has led to the presence of abnormal cervical cells. If a patient’s Pap test is positive, she will likely need a repeat Pap test and/or further testing to determine the cause of her findings.

Will a Pap test show early cancer?

A Pap test can detect early changes in the cervix, including precancerous cells. Again, however, a Pap test is not used to definitively diagnose cervical cancer.

What else is included in a well-woman exam besides a Pap smear?

Because every woman’s needs and history are unique, each well visit is tailored to the patient specifically. Generally speaking, most women can expect some combination of the following services to be included in an annual well-woman visit:

• Discussion of current health and emotional well-being
• Review of medications
• Review of personal and family health history
• Current symptoms or concerns
• Vital signs
• Blood work
• Breast exam
• Pelvic exam
• Pap smear
• Discussion of fertility and family planning (for women in childbearing years)

With the myriad of essential healthcare services included in your well-woman visit, which is considered preventive and is covered by insurance, it is critical that patients schedule their wellness exams each year.

Protect your health and your future with regular Pap smears in Plano, TX

Fortunately, cervical cancer is relatively slow-growing. Even so, successful treatment and cure depend heavily upon catching cervical cancer early. Without a doubt, the Pap smear is one of the most valuable tools for detecting early cervical cancer and increasing a patient’s chance for survival. To learn more about the importance of Pap smears, call Nest Family Medicine to schedule your well-woman visit with board-certified family physician and women’s wellness expert Dr. Priti Ranjan today.

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Well-Woman Exams

Cytological examination of smears (scrapings) from the surface of the cervix (external uterine os) and cervical canal

Cytological examination using a special method of staining the material, which makes it possible to detect atypical cells in a smear with high sensitivity and diagnose early precancerous changes in the epithelium and cervical cancer .

Synonyms Russian

Papanicolaou smear, Pap test, smear for oncocytology.

Synonyms English

Pap smear, Papanicolaou Smear; Cervical Smear; Cervical Oncocytology.

Research method

Cytological method.

What biomaterial can be used for research?

Smear from the outer surface of the cervix, swab from the inner surface of the cervix (from the cervical canal).

General information about the study

Cervical cancer (CC) is the 3rd most common malignant tumor in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer in the world is 15-25 per 100,000 women. Neoplasms of the cervix occur mainly in middle-aged women (35-55 years), are rarely diagnosed under 20 years of age and in 20% of cases are detected over the age of 65 years.

The 5-year survival rate for localized (local, in situ) cervical cancer is 88%, while the survival rate for advanced cancer does not exceed 13%.

Risk factors for cervical cancer include infection with the human papillomavirus (oncogenic serotypes HPV16, HPV18, HPV31, HPV33, HPV45, etc.), smoking, chlamydial or herpetic infection, chronic inflammatory gynecological diseases, long-term use of contraceptives, repeated births , cases of cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient dietary intake of vitamins A and C, immunodeficiencies and HIV infection.

According to international recommendations, all women should be screened (pre-symptomatic) for cervical cancer 3 years after the onset of sexual activity, but no later than 21 years. Starting at age 30, patients who have had 3 consecutive negative cervical smear results may be screened every 2-3 years. Women with risk factors (human papillomavirus infection, immunocompromised conditions) should continue annual screening. Women 65 years of age or older with 3 or more normal cervical smear results in the last 10 years may not be screened. For those who have recovered from cervical cancer, who have a papillomavirus infection or who have a weakened immune system, it is advisable to continue screening. Women who have had their uterus and cervix removed may not have this test if the operation was not due to cancer or a pre-cancerous condition of the cervix. Those who have had uterine-only surgery without cervical removal should continue to participate in screening.

Cytological examination of the material from the cervix and external uterine os, stained according to the Papanicolaou method in compliance with the test methodology and conditions for preparing for analysis, allows with high sensitivity and reliability to identify atypical cells in the material, precancerous conditions (dysplasia, intraepithelial neoplasia of the cervix) . Most often, the biomaterial obtained using a special cytobrush from two points (epithelium of the endocervix and exocervix) and fixed on a glass slide is examined 96% alcohol. Material from the transformation zone should get into the smear, since about 90% of neoplastic conditions come from the junction zone of the squamous and columnar epithelium, and only 10% from the columnar. In this study, signs of the presence of infection, pathology of the endocervix and endometrium can also be detected.

Screening and early diagnosis of precancerous conditions and early stages of cervical cancer allows for timely effective treatment and prevention of dangerous consequences.

What is research used for?

• For screening and diagnosis of cervical precancerous lesions.
• For screening and diagnosis of cervical cancer.

When is the test ordered?

• When periodically examining girls and women 3 years after the onset of sexual activity, but no later than 21 years (it is recommended to take an analysis annually and at least every 3 years).
• Every 2-3 years from age 30 to age 65 with three consecutive negative results.
• Yearly in the presence of human papillomavirus (HPV), immune system weakened by transplantation, chemotherapy, or long-term use of steroid hormones.

What do the results mean?

Bethesda ” The 2001 Bethesda System termin ology ”

1. Material quantity

• Complete material (adequate) – a good quality smear containing a sufficient amount of the appropriate cell types is considered a complete material.
• The material is insufficiently complete (insufficiently adequate) – there are no endocervix cells and / or metaplastic cells in the material, squamous epithelial cells are in sufficient quantity, or the cellular composition is poor.
• The material is defective (inadequate) – it is impossible to judge the presence or absence of pathological changes in the cervix from the material.

2. Interpretation of results:

• Negative Pap test – epithelial cells are within normal limits, the cytogram corresponds to age, normal.
• Benign changes – the presence of non-tumor cells, signs of inflammation (increased number of leukocytes), infection (a significant number of cocci, rods). It is possible to detect infectious agents (indicating the pathogen), for example Trichomonas, yeast.
• Changes in squamous epithelial cells (require increased attention, additional examination and treatment if precancer or cancer is detected):

• • Atypical squamous cells undertermined significance (ASC-US)
  • Atypical squamous cells cannot exclude (HSIL ASC-H)
  • Squamous intraepithelial lesion (SIL)
  • Low grade squamous intraepithelial lesion (LSIL)
  • High grade squamous intraepithelial lesion (HSIL)
  • Cervical intraepithelial neoplasia grade 1, 2 or 3, CIN 1, 2, 3
  • Carcinoma in situ (CIS)
  • Squamous cell carcinoma – invasive cancer

• Changes in glandular cells (require increased attention, additional examination and treatment if precancer or cancer is detected):

• • Atypical glandular cells (AGC)
  • Atypical glandular cells, favor neoplastic, AGC, favor neoplastic
  • Adenocarcinoma

Testing for oncogenic human papillomavirus serotypes is recommended if minimal changes or atypical cells of unclear significance are detected.

What can influence the result?

False-positive results are possible in girls younger than 20 years due to the presence of changes in the epithelium against the background of transient hormonal disorders.

Important Notes

• There is a possibility of a negative test result with changes in the epithelium in the cervix, so it is important to undergo regular re-examinations.

Also recommended

• Cytological examination of smears (scrapings) from the surface of the cervix (external uterine os) and cervical canal for atypia
• Squamous cell carcinoma antigen (SCCA)
• Human Papillomavirus of high carcinogenic risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59), DNA genotyping [real-time PCR]
• Human Papillomavirus of high carcinogenic risk (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59), DNA quantification, no typing [real-time PCR]

Who orders the examination?

Gynecologist, oncologist.

Literature

• Apgar BS, Zoschnick L, Wright TC (November 2003). “The 2001 Bethesda System terminology”. Am Fam Physician 68(10): 1992-8. PMID 14655809.
• Arbyn M. et al. (2010). “European Guidelines for Quality Assurance in Cervical Cancer Screening. Second Edition – Summary Document”. Annals of Oncology 21(3): 448–458.
• American College of Obstetricians and Gynecologists, “ACOG Committee Opinion No. 483: Primary and Preventive Care: Periodic Assessments,” 2011, Obstet Gynecol, 2011, 117(4):1008-15. PubMed 21422880.
• Novik VI Epidemiology of cervical cancer, risk factors, screening.

Early detection of cervical cancer using a Pap smear in Israel – Medical Center. Rabin.

Cervical cytology or Papanicolaou (Pap) test is currently one of the main methods for early detection of malignant changes in cervical cells. This test helps confirm or exclude the existence of precancerous changes in the cervix, and sometimes even detect cancer.

A Pap test is required for all women over the age of 25, even if they have been vaccinated against HPV (human papillomavirus). If the Pap test shows no abnormality, you will receive a written notification from the laboratory or from your gynecologist. If abnormal cells are suspected, your gynecologist will refer you for further tests. It is important to note that the Pap test is the primary screening. The detected anomalies do not necessarily indicate infection with the papillomavirus.

Reasons for a positive Pap test can range from laboratory error, local irritation or inflammation of the cervix, to endometrial cancer and cervical cancer. In any case, after a positive Pap test, the woman is referred for a colposcopy and biopsy.

Colposcopy is a diagnostic procedure in which a doctor examines the cervix under 10x magnification to look for damage. During a colposcopy, your doctor may take a small sample of tissue (biopsy) for laboratory testing of the damaged area. Depending on the nature of the injury, the doctor will recommend observation or surgery.

In cases where there is a suspicion of precancerous changes, surgical removal of the affected tissue is performed – conization. This is done on an outpatient basis under local or general anesthesia, depending on the size of the lesion and the desire of the patient. If the lesion is precancerous, then conization is often the only thing that is done in this case.

In cases where a cervical tumor has been diagnosed, a radical mastectomy and removal of the pelvic lymph nodes is recommended, although in some cases only resection of the cervix and pelvic lymph nodes is sufficient. In a situation where the tumor has spread to neighboring organs or lymph nodes, the patient is prescribed a course of radiation therapy in the pelvic area.

At the Rabin Medical Center, these operations are performed using a minimally invasive method using robotic assistance. The use of robots in operations allows achieving maximum accuracy in the surgery of damaged tissues, minimizing damage to neighboring healthy tissues and, therefore, ensuring a quick recovery (discharge from the hospital within 24 hours) and the return of the patient to full activity.