Screening
It is very important to be examined for cervical changes before there are symptoms. Screening can help the doctor find abnormal cells before cancer develops. Finding and treating these abnormal cells can prevent most cervical cancer. Also, screening can help find cancer early, when treatment is more likely to be effective.
Today, screening has a powerful new component: the ability to test for the presence of HPV. This augments the Pap smear and other methods in early detection and disease prevention.
For the past several decades, the number of women diagnosed each year with cervical cancer has been decreasing. Doctors believe this is mainly because of the success of screening.
Pap smear
Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a small sample of cells from the cervix. A lab checks the cells on the slides under a microscope for abnormalities.
Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that women:
- begin having Pap tests three years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first).
- should have a Pap test at least once every three years.
- aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.
- who have had a hysterectomy to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening.
Women should talk with their doctor about when they should begin having Pap tests, how frequently and when they can stop having them. This is especially important for women at higher-than-average risk of cervical cancer.
Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips:
- Do not douche for 48 hours before the test
- Do not have sexual intercourse for 48 hours before the test
- Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams or jellies for 48 hours before the test
Doctors also suggest that a woman schedule her Pap test for a time that is 10 to 20 days after the first day of her menstrual period.
Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may develop into cancer over time:
- LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women, yet are are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer.
- HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.
The HPV test is usually performed at the same time as a Pap smear, and analyzes the DNA of cervical cells for the presence of HPV. It is usually performed in women 30 or older.
A positive HPV test result only indicates the presence of the virus; it does not mean the woman has cervical cancer. A positive HPV test result signals a doctor to examine the Pap smear for any precancerous changes. A colposcopy and/or biopsy may then be ordered to detect abnormal cervical cells.