What are the recommended screening methods for cervical cancer. How often should women undergo cervical cancer screening. What do Pap smear and HPV test results indicate. How can early detection impact cervical cancer outcomes.

The Importance of Cervical Cancer Screening

Cervical cancer screening plays a crucial role in women’s health by detecting abnormal cell changes before they develop into cancer. Regular screening can prevent cervical cancer or catch it at an early, highly treatable stage. The two primary screening methods are the Pap test (or Pap smear) and the HPV test.

What is a Pap Test?

A Pap test examines cells collected from the cervix to look for precancerous changes. During the procedure, a doctor uses a speculum to view the cervix and collect a small sample of cells. These cells are then analyzed in a laboratory to check for any abnormalities that could indicate precancer or cancer.

What is an HPV Test?

The HPV test looks specifically for the presence of human papillomavirus, which is responsible for causing most cases of cervical cancer. This test can be performed using the same cell sample collected during a Pap test or as a standalone screening.

Recommended Screening Guidelines by Age

Cervical cancer screening recommendations vary based on a woman’s age and risk factors. Here are the current guidelines:

• Ages 21-29: Pap test every 3 years
• Ages 30-65: HPV test every 5 years, or co-testing (HPV test + Pap test) every 5 years, or Pap test every 3 years
• Over 65: Screening may be discontinued if previous results have been consistently normal

It’s important to discuss your individual screening needs with your healthcare provider, as factors like medical history and risk level can influence the recommended schedule.

Understanding Screening Results

Receiving your cervical cancer screening results can be anxiety-inducing, but it’s crucial to remember that abnormal results don’t necessarily indicate cancer. Here’s what different outcomes might mean:

Normal Results

If your screening results are normal, it means no abnormal cells were detected. This indicates a very low risk of cervical cancer in the near future. Your doctor will advise when to schedule your next screening based on your age and risk factors.

Abnormal Pap Test Results

Abnormal Pap test results can indicate the presence of atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesions (LSIL), or high-grade squamous intraepithelial lesions (HSIL). These findings suggest varying degrees of cell changes that may require further investigation or monitoring.

Positive HPV Test

A positive HPV test means that high-risk HPV types were detected in your sample. This doesn’t necessarily mean you have or will develop cervical cancer, but it does indicate an increased risk. Your doctor may recommend more frequent screening or additional tests to monitor for any cell changes.

The Role of HPV in Cervical Cancer

Human papillomavirus (HPV) is the primary cause of cervical cancer. Understanding the link between HPV and cervical cancer can help women better appreciate the importance of regular screening and HPV vaccination.

How Does HPV Cause Cervical Cancer?

HPV is a common sexually transmitted infection that can infect cells in the cervix. While most HPV infections clear on their own, persistent infections with high-risk HPV types can lead to cellular changes that may eventually develop into cancer if left untreated.

HPV Vaccination

HPV vaccination is a powerful tool in preventing cervical cancer. The vaccine protects against the most common high-risk HPV types responsible for cervical cancer. It’s most effective when given before exposure to HPV, which is why it’s recommended for both girls and boys starting at age 11 or 12.

Preparing for Your Cervical Cancer Screening

Proper preparation can help ensure accurate results from your cervical cancer screening. Here are some guidelines to follow:

• Avoid sexual intercourse for 24-48 hours before the test
• Don’t use douches, tampons, or vaginal medications for at least 24 hours prior to the test
• If possible, schedule your appointment when you’re not menstruating
• Inform your healthcare provider of any medications you’re taking, including birth control

If you’re menstruating on the day of your appointment, contact your healthcare provider. In many cases, the screening can still be performed.

What Happens During a Cervical Cancer Screening?

Understanding what to expect during a cervical cancer screening can help alleviate anxiety and ensure a more comfortable experience. Here’s a step-by-step breakdown of the procedure:

1. You’ll be asked to undress from the waist down and lie on an exam table with your feet in stirrups.
2. The healthcare provider will gently insert a speculum into your vagina to visualize the cervix.
3. For a Pap test, a small brush or spatula will be used to collect cells from the cervix.
4. If an HPV test is being performed, the same sample can typically be used.
5. The speculum is removed, and you can get dressed.

The entire procedure usually takes just a few minutes and, while it may cause some discomfort, it shouldn’t be painful. If you experience pain, inform your healthcare provider immediately.

Beyond Screening: Other Factors in Cervical Cancer Prevention

While regular screening is crucial for early detection and prevention of cervical cancer, there are other steps women can take to reduce their risk:

Lifestyle Factors

Certain lifestyle choices can impact cervical cancer risk. These include:

• Quitting smoking or never starting
• Maintaining a healthy diet rich in fruits and vegetables
• Practicing safe sex to reduce HPV exposure
• Limiting the number of sexual partners

Regular Health Check-ups

In addition to cervical cancer screening, regular check-ups with your healthcare provider can help identify and address other health concerns that may impact your cervical health.

Knowing Your Family History

A family history of cervical cancer or other gynecological cancers may increase your risk. Share this information with your healthcare provider, as it may influence your screening schedule or prompt additional preventive measures.

Addressing Common Concerns and Misconceptions

Many women have questions or concerns about cervical cancer screening. Addressing these can help encourage regular screening and early detection. Here are some common issues:

Is cervical cancer screening painful?

While some women may experience discomfort during a Pap test or HPV test, the procedure should not be painful. If you experience pain, communicate this to your healthcare provider immediately. They can adjust their technique or provide guidance on how to relax during the exam.

Can I get cervical cancer if I’m not sexually active?

While the majority of cervical cancers are caused by HPV, which is sexually transmitted, it is technically possible to develop cervical cancer without being sexually active. However, this is extremely rare. Regardless of sexual activity, following recommended screening guidelines is important for all women.

Do I still need screening if I’ve had the HPV vaccine?

Yes, even if you’ve received the HPV vaccine, regular cervical cancer screening is still recommended. The vaccine doesn’t protect against all types of HPV that can cause cervical cancer, and it’s most effective when given before HPV exposure.

What if I can’t afford screening?

Cost should not be a barrier to cervical cancer screening. Many health insurance plans cover preventive services like Pap tests and HPV tests. For those without insurance or with limited coverage, programs like the National Breast and Cervical Cancer Early Detection Program provide free or low-cost screening to eligible women.

The Future of Cervical Cancer Screening

As medical technology and our understanding of cervical cancer continue to advance, screening methods are evolving. Here are some developments on the horizon:

At-Home HPV Testing

Researchers are exploring the possibility of at-home HPV testing kits, which could increase screening rates by providing a more convenient option for women. While these tests are not yet widely available, they show promise for the future of cervical cancer screening.

Artificial Intelligence in Screening

AI technologies are being developed to assist in analyzing Pap test results, potentially improving accuracy and efficiency in detecting abnormal cells. These tools could help reduce human error and provide more consistent results.

Personalized Screening Schedules

As we learn more about individual risk factors for cervical cancer, screening guidelines may become more personalized. This could mean more frequent screening for high-risk individuals and less frequent screening for those at lower risk.

Regular cervical cancer screening remains a cornerstone of women’s health care. By understanding the importance of these tests, following recommended guidelines, and staying informed about new developments, women can take proactive steps to protect their health and prevent cervical cancer. Remember, early detection through screening can save lives, making it a crucial part of every woman’s healthcare routine.

What Should I Know About Cervical Cancer Screening?

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“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.