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.

What Does a Pap Test Detect?

Updated November 2022

Its real name: Papanicolaou test. There’s a good chance you know it as a Pap smear, or more appropriately, a Pap test. Discover the science behind this test ­— including what it doesn’t detect.

The Science Behind the Test

A Pap test is when a clinician takes a sample of cells from your cervix (the lower part of the uterus neck located at the top of the vagina). Then, they put the cells into small jar with a special liquid to preserve the sample so it can be tested for abnormalities under a microscope.

There are many reasons why you may have abnormal findings, such as:

• Mild inflammation
• Human papillomavirus (HPV)
• Cancer or precancer

Cervical cancer, if caught early, is highly treatable.

— Melissa A. Simon, MD

“The Pap test can detect changes in cells that could be concerning for possible cervical cancer or precancerous changes,” says Melissa A. Simon, MD, an obstetrician and gynecologist at Northwestern Medicine. 

Abnormal test results will indicate a number of atypical squamous cells, which will then be classified as low-grade or high-grade squamous intraepithelial lesions (LSIL and HSIL, respectively). LSIL indicates that the changes are mildly abnormal and usually caused by HPV infection, and they may go away on their own. HSIL suggests more serious changes.

“Cells that are determined to be atypical of undetermined significance basically reveal slightly abnormal cells, and it does not clearly mean precancer is there. Usually, these test results indicate to follow up in a year,” says Dr. Simon.

Abnormal Pap test results are typically caused by HPV. HPV is a sexually transmitted infection (STI) that enters cells and changes them. HPV can be prevented by getting the vaccine, which targets the HPV types that most commonly cause certain types of cancer and genital warts. Certain high-risk types of HPV are associated with an increased risk for the following types of cancer:

• Cervical
• Vulva
• Vagina
• Penis
• Anus
• Mouth and throat cancer

Depending on your Pap test results, your physician will determine the appropriate next steps. This can include another test, known as a colposcopy, which uses a special camera to look at your cervix. During this procedure, a biopsy of cells on your cervix may be taken for further analysis. Your physician may also opt for a loop electrosurgical excision procedure, known as LEEP, if there are more concerning findings or repeated abnormal Pap test results. A LEEP removes part of your cervix tissue for diagnosis and/or treatment.

What It Can’t Determine

Although Pap tests can help detect precancerous cells on the cervix, there are other types of gynecologic cancers that Pap tests cannot detect.  

Because your ovaries are far away from your cervix, it is extremely unlikely that a Pap test will  detect ovarian cancer. For that to happen, the cancer cells would have to travel away from your ovaries, through your fallopian tubes and uterus, and into the area surrounding your cervix.

The Pap test is also limited in detecting other types of STIs. If you are concerned you may have a STI, you should ask your clinician to screen for specific STIs.

Pap Tests Are Part of Routine Screening

The U.S. Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) both suggest starting screening at age 21. However, the American Cancer Society suggests that cervical cancer screening begin at age 25.

Dr. Simon explains that there are many nuances and complexities of when to start screening and how frequently screening should be done. Cervical cancer can also take a long time to develop, which could explain the varying guidelines.

Screening with a Pap test every three years during this time period is acceptable. However, other types of screening include primary HPV testing every five years. If primary HPV testing is not available, screening may be performed with co-testing that combines an HPV test with a Pap test every five years.

“If you have vaginal discharge, abnormal bleeding or are feeling pain, schedule a visit with your healthcare clinician to discuss these symptoms,” says Dr. Simon. “It’s important that if you are ever in any doubt of what you are feeling or experiencing, and are questioning if you need screening or a test, always reach out to your care team so you can have that conversation.”

The USPSTF, ACOG and American Cancer Society agree that people older than 65 do not need to be screened if adequate prior screening has been completed with normal results and if there is no history or high risk of cervical cancer. Dr. Simon recommends talking to your primary care clinician about your individual risks and recommendations for screening.

Bottom Line

The Pap test is a screening tool that can help detect abnormal cells on your cervix. This early detection can be important in stopping precancerous cells from progressing to cervical cancer.  

“Cervical cancer, if caught early, is highly treatable. And that’s why engaging in routine screening is very important,” says Dr. Simon. “Between the HPV vaccine and routine testing, this type of cancer really should be nonexistent.”

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 material from the cervix and external uterine os, stained according to the Papanicolaou method in compliance with the test procedure 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, biomaterial obtained using a special cytobrush from two points (endocervix and exocervix epithelium) 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?

In girls younger than 20 years, false-positive results are possible 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 have 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.

Pap smear for HPV in Moscow – Prices for Pap test – Cost of a smear for HPV cytology

Pap smear for HPV in Moscow – Prices for a Pap test – The cost of a smear for HPV cytology

12/11/2020

Pap smear for HPV (Pap test) in gynecology

HPV oncocytology smear (Pap smear, Pap test in gynecology, Pap test, screening for cervical cancer, smear for cytology, smear for atypical cells) is the leading screening method for diagnosing diseases of the cervix, allowing to assess the condition of its mucous membrane , the presence of background changes in the epithelium, as well as atypical, precancerous cells and cervical cancer.

The “gold standard” of cytological diagnosis of cervical cancer in the world is liquid oncocytology – a modified method of cytological smear, when the biomaterial is transferred not to glass, as was done before, but entirely, together with a cytobrush, into a container with a liquid medium. After that, the composition is washed off by a special method from elements that impede cytological diagnosis (mucus, leukocytes, erythrocytes, detritus, inflammation elements), and the sample is subjected to microscopic examination.

It is important that the cytologist receives 100% of the collected material! This makes the study more accurate. Improving the accuracy of cytological diagnosis when performing a liquid Pap test for HPV is achieved by overcoming all the errors associated with the preparation of a smear.

Pap smear benefits

The advantages of this method are that its sensitivity is much higher than the traditional smear on glass and is 98%. All this makes the cytological examination of smears according to the Papanicolaou method more informative, and the conclusion reliable. As a result, the proportion of false-negative results of the cytological examination, which is carried out at the H-Clinic, is reduced, and the reliability of diagnosing diseases of the cervix in general is significantly increased.

The leading factor in the development of cervical cancer is the presence of oncogenic types of human papillomavirus in the cervical epithelium (in 99.7% of cases of cervical cancer, papillomavirus DNA was isolated from tumor samples). In this regard, currently used combined liquid Pap test for HPV , which allows you to assess not only the condition of the cervix at the cellular level, but also to identify the presence of papillomaviruses, indicating their type and viral load, because the activity of the virus and the degree of risk depend on it.

With the help of molecular biological methods, more than 100 serotypes of human papillomaviruses are identified, but at least 19 types are currently classified as oncogenic risk viruses:

• 16, 18 types are the most oncogenic, 70% of all cases of diagnosed oncology;
• 31, 33 – also belong to high-risk papillomaviruses;
• 30, 35, 39, 45, 52, 53, 56, 58 types – medium risk;
• 6, 11, 40, 42, 43, 44, 61 types – low risk.

For a long time, cervical cancer has consistently ranked 5th in the structure of oncological morbidity among women in Russia. In 2018, 17,766 cases were identified. Moreover, over the years, the growth rate of cases of this oncology is only gaining momentum. For 10 years, the indicator increased by 4.47% percent and the average growth rate was about 2.19% in year. In the same 2018, 6,392 women died of cervical cancer. Moreover, there is a clear increase in mortality in the age group among women 35-59 years old.

Thus, the picture is more than sad: every day we lose 17 young women from cervical cancer. The entire civilized world has been vaccinating its population against HPV for more than 15 years, critically reducing the risks of developing this disease (vaccination against the human papillomavirus in more than 100 countries is included in the national vaccination schedule).

In Russia, the vaccine is administered at the request of the patient (or the consent of the girl’s mother), in the list of mandatory vaccination (it is not yet included in the national Immunization Calendar.

Given the etiological factor of cervical cancer, the incidence and mortality figures in Russia, it is difficult to overestimate the vaccination of human papillomavirus infection. Vaccination eliminates the root cause, and screening reduces not only mortality, but also the incidence of cervical cancer, since thanks to modern diagnostic methods, the doctor can identify not only background processes that can lead to cancer, but also diagnose precancerous conditions and carry out the necessary treatment of an infectious disease in time .

Indications for Pap test in gynecology

According to current recommendations, screening for cervical cancer should begin within the first year after the onset of sexual activity, but no later than 21 years.

Women aged 21 to 29 should be screened at least once every 3 years by cytology alone (assuming 3 consecutive smears are free of atypical and intraepithelial changes). Women aged 30 to 65 years should have combined cytology plus HPV screening – typing at least every 1-5 years, or at least every 1-3 years if screening includes only cytology (also if there are 3 x consecutive negative smears for cytology (Pap test) and for HPV).

Screening in women over 65 may be discontinued as recommended:

• if there are three or more reported consecutive negative results in the last 10 years;
• with a negative HPV test;
• no aggravating factors:
  – a history of cervical disease;
  – immunocompromising diseases or conditions, for example, the presence of HIV infection, severe autoimmune diseases;
  – history of transplantation or chemotherapy.

Women who are HIV positive should have a Pap test as soon as possible after diagnosis. Also, screening for women with HIV infection should begin within the first year after the onset of sexual activity, regardless of the mode of transmission of HIV infection, but no later than 21 years.

Further, with a negative Pap test (absence of intraepithelial and / or malignant changes), the next Pap test with a transcript of the test results should be carried out at least 6-12 months later.

If the results of 3 registered consecutive smears are without atypical and epithelial changes, repeated cytological smears should be performed at least after 3 years.

Further, with a negative Pap test (absence of intraepithelial and / or malignant changes), the next Pap smear should be performed at least 6-12 months later.

If the results of 3 registered consecutive smears are without atypical and epithelial changes, repeated cytological smears should be performed at least after 3 years.

Combined HPV-PAP testing, according to current recommendations, should be carried out in women from 30 years of age and older.

Also, according to the recommendations, with a negative PAP test and an analysis for HPV infection, women over 30 years old are allowed to undergo an HPV-PAP test every 3 years.

With a negative PAP test, but the presence of human papillomavirus infection (with the exception of 16 or 16/18 types), women with HIV-positive status should undergo a liquid HPV-PAP test at least once every 12 months.

HIV-positive women should be screened for oncocytology and HPV typing throughout their lives.

If HPV types 16 or 18 and / or atypical epithelial changes are detected, colposcopy is necessary – visually examine the epithelium of the cervix at a 7.5–40-fold increase. A correctly assessed colposcopic picture allows you to identify the affected area and perform a targeted biopsy of the suspicious area of ​​​​the cervix. In the future, after receiving a histological result, the doctor decides on further tactics and algorithm for the management and treatment of HPV and / or cancer.

Papanicolaou stain

How to prepare for testing

Preparing for a Pap smear from the cervix is ​​simple and easy:

• It is not recommended to take a Pap test during menstruation and no later than 5 days before it;
• Avoid sexual activity for 48 hours prior to study;
• Do not perform within 24 hours prior to vaginal ultrasound examination;
• Do not use vaginal forms of drugs/remedies within 24-48 hours prior to the study;
• It is not recommended to take a Pap test in the presence of sexually transmitted infections, microflora disorders and inflammation of the vaginal mucosa, as well as during the treatment of these diseases.