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HPV Test & Pap Test: Cervical Cancer Screening Methods

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.

Contributors

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?



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


Table listing possible Pap test results and what they mean
Overview of Pap test results, by Alessandra Papitto and Juliëtte Gossens

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?

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.


 

References


  1. World Health Organization. Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer [Accessed February 10th, 2023]

  2. Frumovitz M. Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. In: Goff B, Dizon DS, Chakrabarti A (eds.). UpToDate. 2023.

  3. 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

  4. 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.

  5. 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

  6. 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]

  7. 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.

  8. 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.

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