Cervical Cancer: Screening

Getting screened for cervical cancer can help you take charge of your health. Screening tests can sometimes find certain cancers early when they're small and before they've spread or caused symptoms. Cancer that is found early is often easier to treat.

When you go for a cervical cancer screening, you can expect to have a few tests, including:

• Pap test. This test finds both cervical cancer and changes in cells of the cervix before they become cancer. These are called precancers.
• HPV test. This test is used to find signs of human papillomavirus (HPV) infection in the cells of the cervix. Certain types of HPV are linked to cervical cancer. Sometimes, the HPV test is done along with the Pap test. It's then called an HPV/Pap cotest.
• Pelvic exam. This exam is often done along with Pap and HPV tests. It can help find some cancers of the uterus and other parts of the female reproductive system.

For the screening, you lie on a table with your feet in stirrups. Your knees are apart and bent. Your doctor will place a device called a speculum into your vagina. You may feel pressure as the speculum goes in and slight discomfort if it's cold.

The speculum holds your vagina open while your doctor uses a small brush to scrape cells from your cervix. The cells that are removed are then sent to a lab. The test results may show that the cells are normal. Or the results may show inflammation, abnormal cells, precancer cells, or cancer cells. The HPV test is done on the cells, too. It shows whether you have an HPV infection.

During a pelvic exam, your doctor will put their fingers into your vagina. They will press on your abdomen with their other hand. The doctor is feeling for abnormal lumps (masses) or growths. You may feel a slight discomfort during the exam. But it only takes a few minutes. Your doctor may also do a recto-vaginal exam. During this exam, your doctor puts one finger in your rectum and another finger in your vagina. They then feel the tissue between the two areas.

Some HPV tests may be done by self-collection. You use a long cotton swab to collect a sample from your own vagina. Ask your doctor if this is a choice for you.

The American Cancer Society (ACS) advises that cervical cancer screening start at age 25. Women ages 25 to 65 should be screened with an HPV test collected by your doctor every 5 years. But if an HPV test isn't available, the ACS says that screening can be done with either:

• A Pap test every 3 years, or
• An HPV/Pap cotest every 5 years or
• A self-collected HPV test every 3 years

Women older than age 65 can stop screening if they have been getting screened regularly and their most recent tests have been normal. When you can stop depends on the type of screening test you had. Ask your doctor when you can stop screening.

At any age, women can stop screening if they had a total hysterectomy that included taking out the uterus and cervix, unless it was done to treat cervical precancer or cancer. People who have had a hysterectomy but still have their cervix should keep getting screenings per the guidelines.

Women who have been vaccinated against HPV should still follow the screening guidelines for their age group.

Some other expert groups have slightly different screening recommendations. These groups include the American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the National Cancer Institute. Talk with your doctor about the right screening schedule for you.

Women at high risk for cervical cancer may need to be screened more often. You are at high risk if you:

• Have had cervical cancer, precancer, or abnormal screening test results in the past
• Have an HIV infection
• Have a weak immune system
• Were exposed to a synthetic hormone called DES before birth

Talk with your doctor about the schedule that is best for you.

Even if you don't have health insurance, you can still keep up with cancer screenings.

The National Breast and Cervical Cancer Early Detection Program can help. It offers cervical cancer testing to women with no health insurance for free or at little cost. Each state runs its own program.

Contact your state or your county Department of Health to find a program near you. Other private or volunteer clinics in your area may also provide screenings for free or at a lower cost.