Screening tests for cervical cancer include the HPV test and the Pap test. Getting these tests regularly can protect against the development of cervical cancer, because abnormal cells are caught before it’s too late. Getting vaccinated against the human papillomavirus (HPV) is also very helpful for this.
This article is pending medical review.
Written by Alessandra Papitto
Reviewed by Carolin Becker, Katarzyna Przybył and Sophie Oppelt
Edited by Juliëtte Gossens
Cervical cancer is one of the most common cancers in women and people with a cervix (1). Especially in regions with few health resources, the disease is often fatal.
Fortunately, the development of cervical cancer can be prevented by getting regular screening tests and getting vaccinated against the human papillomavirus (HPV). That’s because HPV causes the majority of cervical cancer cases (2)! The HPV vaccine also lowers the risk of transmission of the virus. You can read more about HPV and the vaccine here. We’ve also given a general overview of cervical cancer in a separate article, where we discuss what cervical cancer is, how it develops, how it’s diagnosed, and how it’s treated.
In this article, we’re giving an in-depth explanation of the two main screening tests available for cervical cancer: the HPV DNA test, and the Pap test. Both are important for detecting
abnormal cells and cancer cells (1, 3).
What is a screening test? Can it confirm a diagnosis?
Screening is a method of testing for disease that is designed to detect as many cases of this disease as possible. Because of this, screenings will often give a positive result (that is, indicate that you have the disease) even when you don’t have the disease. This is called a false-positive result. This characteristic makes screenings unsuitable for confirming a diagnosis. But they are a great tool for deciding who needs further testing. In other words, screenings indicate an increased risk of a disease or abnormality, not a definitive diagnosis. (4)
What we're covering
The HPV Test
The HPV test is used on cervical cancer cells. It can identify parts (antigens, typically DNA) of human papillomaviruses that have high cancer risk. As we explain here, there are lots of different strains of HPV. Only a few can cause cancer. The HPV test focuses on these few.
The sample that’s needed is collected through a swab of the cervix using a small brush. The cells that are in the sample are then analyzed to check for the presence of cervical cancer risk factors, such as bits of HPV (5).
Your doctor or a trained nurse can take the sample while they hold the walls of your vagina open with a speculum. This can be uncomfortable, so let your doctor or nurse know if you’re feeling anxious about it! An advantage of the HPV test is that it’s possible to take the sample yourself. If you’re interested in this, talk to your doctor about it.
Experts recommend women (and everybody else who is at risk) gets screened using the HPV test every 5 to 10 years, starting at age 30 (6, 7). In some countries, screening starts earlier. If you have HIV, it’s recommended that you get screened more often. That’s because HIV makes you more vulnerable to infections. If you’d like to know when you should start getting HPV tests, contact your doctor.
If the HPV test says your cells are infected, a Pap smear can be done.
The Pap Test
The Pap test, or Pap smear, is used to check the cervix for abnormal cells before they develop into cancer. This is done in the same way as for the HPV test: by taking a swab of the cervix. They send your sample to a lab, where the cells in it are examined under the microscope. This is called cytology.
A Pap smear may be uncomfortable, but it’s done quickly. If you get them regularly, abnormal cells get a much lower chance to develop further without being detected. Let your doctor or nurse know if you’re feeling anxious about the process of getting a Pap smear. They can help guide you through the experience!
The results from a Pap test may be normal, meaning there are no changes in your cells, or abnormal. But abnormal tests results are common. Most of the time, they don’t mean that you’re likely to have cervical cancer. It could just be that you have a bit of inflammation in your cervix, for example because you have an infection.
Experts recommend you get screened using Pap tests every 3 years starting at age 30 (7). In some regions, the guidelines might say you should get screened more or less often, or from an earlier age. Contact your doctor to learn how it’s done in your country.
The table below summarizes the possible results you can get from Pap tests, and their meaning. Doctors distinguish between the results based on what the cells look like under a microscope.
Remember: this table is only meant to include some common results and what they might mean. It's possible that results are reported differently in your country! Always contact your own doctor if you want to know exactly what your results mean.
Overview of Pap results
The Pap test is only a screening tool. A Pap test can’t be used to diagnose cervical cancer, because it only looks at individual cells. To diagnose cancer, it’s important to look at how these cells are arranged in relation to each other. This arrangement is called tissue. If needed, your doctor will be able to take some tissue by doing a biopsy. You can read a little more about biopsies here.
Cervical Cancer Screening Program
Depending on where you live, your country may have a national screening program that automatically invites women over a certain age (typically 25 or 30) to get an HPV test or a Pap test every few years (usually every 3 to 5 years, unless your last test was abnormal, then it’s sooner). In other countries, you have to take the initiative to contact your doctor yourself.
If you have HIV, it’s advised to be screened more often (typically every year), because you’re more vulnerable to infections and cancer. Contact your primary care doctor if you’re living with HIV and want to get screened.
Importantly, if your country sends invites, make sure to check whether you’ll be included automatically if you have a cervix but aren’t registered as female with your government. You might also receive invites if you’re registered as female but don’t have a cervix (anymore). In that case, you might still need screening if you’ve had an abnormal test result in the past. Some countries keep track of these things, but others don’t. Contact your GP or primary care doctor to make sure things are in order for you.
Does my country have a screening program?
We’ll only discuss countries with English as their primary language here. Choose the language spoken in the country where you live in the upper left corner (on desktop) or in the menu (on mobile) to learn more about screening in your country.
Disclaimer: we do our best to present up-to-date information, but it’s possible things have changed since we last reviewed this article. That’s why this information is for educational purposes only. Always contact your own healthcare provider (or check your country’s guidelines online) if you have questions about your health and what applies to you.
England: yes, England has a national cervical cancer screening program. In England, you receive an invitation every 3 to 5 years (depending on your age) between the ages of 25 and 64. Everyone registered as female with their GP receives a letter, unless they don’t have a cervix anymore. If you’re registered as male with your GP but you have a cervix, talk to them about getting tested.
Wales: yes, Wales has a national cervical cancer screening program. In Wales, you’re invited every 5 years between the ages of 25 and 64 (this used to be more often in young women but has recently been changed to 5-year intervals). Everybody registered as female or unspecified with their GP receives an invitation. If you’re registered as male but you have a cervix, contact your GP.
Scotland: yes, Scotland has a national cervical cancer screening program. In Scotland, you receive an invitation every 5 years between the ages of 25 and 64. Everyone with a cervix is invited. If you don’t identify as female but have a cervix, and you haven’t changed your Community Health Index (CHI) number or changed it after 14 June 2015, you will receive an invitation. If you changed it before this date, contact your GP.
Northern Ireland: yes, Northern Ireland has a national cervical cancer screening program. In Northern Ireland, you receive an invitation every 3 to 5 years (depending on your age) between the ages of 25 and 64. You will receive an invitation if you’re registered as female with your GP. If you’re not, but you have a cervix, contact your GP.
Ireland: yes, Ireland has a national cervical cancer screening program. Ireland works with a register (the CervicalCheck register) of women with a PPS number between the ages of 25 and 65. If you’re on it, you’ll be sent a letter when your test is due (every 3-5 years, depending on your age). You can also check the register yourself to see when you should be getting tested next. If you’re not on the register, you can fill out a form or book an appointment at a GP or a clinic to have a test. If you get a test, you’ll be added to the register automatically. If you have a cervix but are registered as male with the Department of Social Protection, you won’t receive letters. In that case, you should contact your GP to get screened.
Australia: yes, Australia has a national cervical cancer screening program. In Australia, you receive an invitation every 5 years between the ages of 25 and 74. You can check the National Cancer Screening Register to see when you’re due next. You can get screened by a healthcare professional, or you can ask them about collecting your sample yourself. If you’re registered as female under Medicare, you’ll be added to the register automatically when you turn 25. This is also true if you’re not registered as female but you’ve had a screening test at some point in your life. But if you’ve never had a screening test and you’re registered as male with Medicare, you’re not added to the register when you turn 25. So, if this applies to you but you have a cervix, talk to your GP or a different clinician about getting screened.
New Zealand/Aotearoa: yes, New Zealand/Aotearoa has a national cervical cancer screening program in place. From the age of 25 to 69, you will be invited by your healthcare provider to take part in screening. At the time of writing, this is a Pap smear every 3 years. In July 2023, this will be changed to an HPV test every 5 years. Self-testing will then also become an option.
United States: no, the United States don’t have a nation-wide automatic cervical cancer screening program. But you can get screened by your primary care doctor or your gynecologist, or at a sexual health clinic (including Planned Parenthood). The American Cancer Society recommends that everyone with a cervix get screened with an HPV test every 5 years between the ages of 25 and 65.
Canada: no, Canada does not have a nation-wide cervical cancer screening program. But many provinces do. Only Nunavut, Quebec, and Yukon don’t have any screening program in place. Because the programs in the provinces differ slightly from each other, we won’t discuss each of them separately here. But in general, the Canadian Cancer Society recommends getting a Pap test every 1-3 years from the age of 21. Check your province’s screening program or contact your primary care doctor to see if you’ll be invited or if you have to take the initiative to get screened yourself.
Over the last few years, there has been a switch in general guidelines for cervical cancer screening. In the past, the Pap test was the standard. But it’s now recommended to do HPV testing to start, instead of the Pap test. The World Health Organization (WHO) recommends that everybody with a cervix gets HPV testing done every 5 years, starting from the age of 30. If your HPV test is positive, it can be followed up with a Pap test. For those living with HIV, or a weakened immune system, testing should start from 25 years old and be done every 3 years (6). Remember that these are only WHO recommendations. What your doctor can provide for you might be different from this.
The Pap smear and the HPV test can also be combined. That’s called co-testing. Co-testing is standard in some regions.
One important thing to keep is mind that a positive screening test (positive means that abnormalities were found) doesn’t necessarily mean that you have cervical cancer. But it serves as a red flag that will lead to other, more specific tests. Cervical cancer typically grows slowly, over the course of 5 to 10 years, so catching it early often gives plenty of time to treat it.
Screening in a region with few resources
Lots of places in the world don’t have enough healthcare funding for a cervical cancer screening program like we described above. Or, they could fund it, but they don’t have the infrastructure in place to make it work: not enough transportation, not enough trained doctors, or other issues.
But even if you’re in a place with few resources, it’s possible that your doctor or healthcare provider can give you a screening test for cervical cancer. There are two possible tests they could do: HPV rapid testing and visual inspection (8).
Just like the regular HPV test we described above, the HPV rapid test can detect if the HPV virus is present in the cells of your cervix. But the result is ready much quicker, typically within a couple of hours. The test performs well, but it is a bit less sensitive than the more expensive tests used in countries with more resources, according to research (9). Still, if these tests are available in your region, that’s much better than if no test was available at all.
If your doctor can’t get HPV rapid tests, they might do visual inspection (8, 10). This test involves applying a certain (safe) chemical to the cervix. If there are any abnormalities, your cervix starts to look a bit different and your doctor can see those changes. This way of testing is less sensitive than testing for HPV, but it can still prevent a lot of cancer diagnoses.
Often, if your doctor does either (or both) of these tests and finds an abnormality, they will want to treat you immediately. That way, you don’t have to come back a different time for treatment, which can be helpful if your clinic or hospital is difficult to get to or very busy.
In summary, regular screening and HPV vaccination are the most effective ways to prevent cervical cancer. That’s because screening can detect abnormal cells before they become cancer, and the HPV vaccine can prevent infection with HPV, the most common cause of cervical cancer. You can read more about the HPV vaccination here.
World Health Organization. Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer [Accessed February 10th, 2023]
Frumovitz M. Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. In: Goff B, Dizon DS, Chakrabarti A (eds.). UpToDate. 2023.
Alrajjal A, Pansare V, Choudhury MSR, Khan MYA, Shidham VB. Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System. CytoJournal. 2021;18:16. DOI: 10.25259/Cytojournal_24_2021
Maxim LD, Niebo R, Utell MJ. Screening tests: a review with examples. Inhalation Toxicology. 2014;26(13):811-828. DOI: 10.3109/08958378.2014.955932.
Johnson CA, James D, Marzan A, Armaos M. Cervical Cancer: An Overview of Pathophysiology and Management. Seminars in Oncology Nursing. 2019;35(2):166-74. DOI: 10.1016/j.soncn.2019.02.003
World Health Organization. New recommendations for screening and treatment to prevent cervical cancer. https://www.who.int/news/item/06-07-2021-new-recommendations-for-screening-and-treatment-to-prevent-cervical-cancer [Accessed February 10th, 2023]
Feldman S, Goodman A, Peipert JF. Screening for cervical cancer in resource-rich settings. In: Goff B, Elmore JG, Chakrabarti A, GIvens J (eds.). UpToDate. 2022.
Federatie Medisch Specialisten. Cervixcytologie. Available from: https://richtlijnendatabase.nl/richtlijn/cervixcytologie/diagnostiek/keuze_voor_test_test_traject/codering_van_de_uitslag.html [Accessed February 10th, 2023]
Please note: the information we provide to you here is for educational purposes only. If you’re experiencing any discomfort or have any complaints or questions about your health, please contact your doctor or other relevant health professional. We don’t provide medical advice.