Screening is a way to evaluate people without symptoms to determine if they are at risk for cancer or have already developed cancer.

Screening for cervical cancer involves:

  • Assessing your medical history and lifestyle habits that may increase or decrease your risk of cervical cancer
  • Tests to identify early signs of cervical cancer

In the U.S., the number of new cases and deaths due to cervical cancer are decreasing each year. Experts agree that this is due to early detection and treatment. Early detection and treatment are possible because of the widespread availability and use of cervical cancer screening methods—the pelvic exam and Pap test.

Screening Guidelines

In November 2002, the American Cancer Society released new guidelines for cervical cancer screening:

  • Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than 21 years of age.
  • Cervical screening should be done every year with regular Pap tests or every two years using liquid-based Pap tests. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. But a doctor may suggest getting the test more often if a woman has certain risk factors.
  • Women 70 years of age and older who have had three or more normal Pap test results and no abnormal results in the last 10 years may choose to stop cervical cancer screening.
  • Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer or precancer. Some other special conditions may require continued screening. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.

Screening Tests

Pelvic Exam

A pelvic exam is done in a doctor’s office. You will change into a dressing gown and lie back on the examination table. There will be stirrups at the end of the table where you can rest your feet. The doctor may complete other aspects of a physical exam first, including examining your thyroid gland, heart, lungs, breasts, and abdomen. As part of the pelvic exam, your external genitalia will be examined for signs of infection or redness. Next, the doctor will slide a speculum into your vagina. This allows the area to be opened slightly. This should not hurt or pinch, but may be slightly uncomfortable. You also may feel a bit nervous or anxious. Try to take slow, deep breaths to help yourself relax.

At this point, the doctor will perform a Pap test (see below for a description of this procedure). The doctor may also do additional tests to check for sexually transmitted diseases, such as chlamydia or gonorrhea. After the doctor is done, the speculum will be removed. The doctor will then place two gloved fingers into the vagina while pressing on your lower abdomen. This identifies the size, shape, and position of your uterus, fallopian tubes, and ovaries. The doctor may then place one finger in your vagina and one finger in your rectum to examine the tissues separating those organs.

You should not feel pain during the exam, but you may feel slight pressure. If you are experiencing pain, tell your doctor immediately. You may have a trace of vaginal bleeding afterwards.

Pap Test

The Pap test takes place during the pelvic exam. Once the doctor has inserted the speculum into your vagina, your cervix will be visible. The doctor will use a flat stick or a soft brush to collect a sample of cells from the cervix and upper vagina. These cells are placed on a slide or suspended in an aqueous solution and sent to a laboratory for evaluation. Your doctor should have the results of your Pap test in 1-3 weeks. If any abnormalities are found, your doctor will call you and discuss follow-up care.

If there are any abnormalities, your Pap test results will probably be reported in the Bethesda System. This system divides cervical cell abnormalities into three major categories:

  • ASCUS - atypical squamous cells of undetermined significance. Squamous cells are the thin flat cells that form the surface of the cervix.
  • LSIL - low-grade squamous intraepithelial lesion. Low-grade means there are early changes in the size and shape of cells. The word lesion refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells.
  • HSIL - high-grade squamous intraepithelial lesion. High-grade means that there are more marked changes in the size and shape of the abnormal (precancerous) cells that look very different from normal cells.

The Pap test is a screening test; it does not provide a diagnosis of cervical cancer. If you have abnormal Pap test results, you will need to have additional tests, such as a colposcopy and biopsy (see ]]>Diagnosis page]]> ). This will help your doctor determine whether there have been precancerous changes to your cervix or if cervical cancer exists.

The Pap test is an effective screening method. However, false-negative smear rates of 3% to 30% have been reported. If you are concerned about the accuracy of your Pap test results, discuss the results with your doctor and ask about the quality control measures that were taken in the laboratory where the sample was evaluated.

Preparing for a Pap Test

When planning for your pelvic exam and Pap test, keep the following things in mind:

  • Do not schedule the Pap test during your menstrual period. If possible, schedule it two weeks after the first day of your period.
  • Do not use vaginal creams, medications, or douches for 72 hours before the test.
  • Do not use contraceptives such as spermicidal foams, creams, or jellies for 72 hours before the test.
  • Do not have intercourse for 24 hours before the test.