Cervical Cancer Screening

Quick look at cervical cancer screening

Cervical cancer screening refers to two tests, the Pap smear and HPV (human papilloma virus) test. These tests examine cells on a woman’s cervix to detect cancer or conditions that may lead to cervical cancer.

The benefits of cervical cancer screening include the potential to detect abnormal cells before they develop into cancer and the detection of HPV infection, which can lead to cervical cancer.

Frequency of testing for women over 21 and under 65 should be every three years, with an HPV test occurring every five years for women over 30.

What is cervical cancer screening?

Cervical cancer screening refers to two types of gynecological tests that detect cancer or precancerous changes of the cervix and the presence of human papilloma virus. The cervix is the lower part of the uterus that connects to the vagina. HPV is a virus that causes about 70 percent of cervical cancer cases.

Precancerous cells and HPV may indicate that a woman is at risk for developing cervical cancer. When abnormal conditions are detected during screening, further examination may be required. Additionally, treatment can be performed to prevent cancer from developing. Current screening guidelines are designed to prevent the development of cervical cancer altogether.

Pap smear

A Pap smear collects a sample of cells from a woman’s cervix for laboratory analysis. During a Pap smear, the patient lies on her back on an exam table and places her feet in stirrups. The physician then inserts an instrument called a speculum into the vagina to expose a portion of the cervix.

The cervix is gently brushed and a sample of cells is collected. The procedure may cause mild discomfort, a sensation of pressure, and rarely some lingering cramping afterward.

The Pap smear can detect precancerous cervical cells as well as other abnormal conditions such as inflammation or infection. While the Pap smear can detect cancer cells, it usually catches abnormal cells before they develop into cancer.

HPV test

The HPV test is often performed at the same time as a Pap smear, using the same sample collected from the Pap. When testing cervical cells for HPV, laboratory technicians examine DNA to detect specific types of HPV that are known to cause cervical cancer.

HPV is the root cause of the vast majority of cervical cancers. HPV is a very common sexually transmitted disease, affecting up to 80 percent of all sexually active people at some point during their life.

It is important to remember that HPV does not usually lead to cancer. There are over 150 known types of HPV, and only a few of these types are known to cause cancer. Two strains alone cause about 70 percent of cervical cancer cases.

The Centers for Disease Control and Prevention (CDC) recommends that all children receive a series of HPV vaccines at age 11 or 12. Women age 26 and younger can receive the vaccines if they did not receive them in childhood. The vaccines effectively prevent the majority of cancers caused by HPV, including cervical cancer.

How often is cervical cancer screening needed?

All women over the age of 18 should receive an annual well-woman exam, which includes a breast and pelvic exam. An annual well-woman pelvic exam does not always include a Pap smear or HPV test because cervical cancer screening is not recommended annually.

Instead, the American College of Obstetricians and Gynecologists (ACOG) advises that women over 21 receive cervical cancer screening as part of their annual exam every three years. Women 30 and older are advised to get an HPV test every five years along with their Pap smear.

Once a woman has reached age 65, she may discontinue cervical cancer screening, provided she has established a history of negative screenings.

Preparing for a screening

Historically, patients were advised against scheduling a Pap smear while having their period (menstruating), as blood could affect the accuracy of the test. With newer technology, light to moderate menstrual flow does not usually affect the Pap test.

The majority of the time, women do not need to reschedule their appointment due to vaginal bleeding. Women should let their doctor know if they are experiencing any abnormal bleeding or if they suspect they may be pregnant.

Additionally, women should avoid the following activities during the 24 hours leading up to a Pap smear:

• Having intercourse
• Using tampons
• Using vaginal medications
• Douching (it is our recommendation that women avoid douching always).

Further testing and treatment for cervical abnormalities

If abnormalities are detected during routine screening, additional examination is usually advised. The physician also will advise the patient on the appropriate treatment methods.

Colposcopy

A colposcopy is a procedure in which the doctor uses a special instrument called a colposcope to look closely at the tissue of the cervix, vagina and vulva. The colposcope gives the doctor a much more detailed view of the cervix and surrounding tissues than the naked eye.

The procedure is performed similarly to a Pap smear, with the patient placing her legs in stirrups. The doctor will use a speculum to hold the vagina open. As part of the colposcopy, a solution is applied to the cervix and vagina to make abnormalities more visible.

The view provided by the colposcope allows the doctor to pinpoint the underlying reason for abnormal screening results. During a colposcopy, a biopsy may be taken to determine if abnormal tissues contain cancerous or precancerous cells.

Loop electrosurgical excision procedure (LEEP)

This procedure may be performed during colposcopy, and it is used to both diagnose and treat abnormal cervical cells. It uses an electrically charged wire loop to remove tissue from the cervix, either for biopsy and diagnosis or because the cells in the tissue have been identified as abnormal or precancerous.

Prior to the procedure, local anesthetic is injected into the cervix through a needle and syringe, preventing the patient from feeling pain from the LEEP instrument. During the injection, the woman will feel a slight sting that may be followed by a subtle ache. The procedure itself usually takes just a few minutes. A special paste is sometimes used to control bleeding once tissue removal is complete.

Following LEEP, the cervix will require a few weeks to heal. During this healing period, a woman should avoid intercourse or inserting anything into the vagina, including tampons. Some discharge is to be expected. The discharge may be clear with a pink tinge or dark brown resulting from the paste that was applied to control bleeding.