Cervical Cancer Screening — what the evidence says

What is cervical cancer screening? Cervical cancer is cancer that starts in the cells of the cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal).

Cervical cancer screening is an important part of routine health care for people who have a cervix. Cervical cancer screening tests look for cancer before you have any symptoms. Cervical cancer usually develops slowly. Before cervical cells become cancer, they start to look abnormal.

These cells are called "precancers". If they aren't destroyed or removed, they may become cancer cells that grow out of control and spread to other parts of your body. Screening can help find abnormal cells so you can get treatment to prevent cervical cancer. These tests can also help to find cervical cancer early when it's usually easier to treat.

What tests screen for cervical cancer? Cervical cancer screening is usually part of a woman's health checkup during a pelvic exam. These tests use a sample of cervical cells that your health care provider collects with a swab: A Pap test (also called a Pap smear or cervical cytology) checks for abnormal cells so they can be treated before they become cancer. An HPV (human papillomavirus) test checks for certain HPV infections that can cause cancer.

HPV is a group of viruses that spread through sexual contact. The types that cause cancer are called "high-risk HPV." The HPV/Pap cotest uses an HPV and Pap test together to check for both high-risk HPV and cervical cell changes. If your screening tests are abnormal, your provider may do more tests, such as a biopsy. How often you should be screened for cervical cancer and which tests you should get will depend on your age and health history.

What are the possible benefits and harms of cervical cancer screening? Cervical cancer screening saves lives. Screening can detect cervical changes early, lowering your chance of dying from cervical cancer. But, cervical cancer screening has potential harms.

The possible harms of cervical cancer screening include: The results can sometimes be wrong. Getting a false-positive result means that your test results appear abnormal, but there are no precancerous or cancerous cells. A false-positive may lead to:
Worry while you have more tests to look for signs of cancer. Follow-up tests or treatment that you may not have needed.

Getting a false-negative result means that your test results appear normal, but there are precancer or cancerous cells. A false-negative may lead to:
You may delay seeking treatment even if you have symptoms. Should I be screened for cervical cancer? Talk with your provider about how often you should be screened for cervical cancer and which tests you should get.

This will depend on your age and health history. If you have a cervix, it's recommended that you have your first Pap smear at age 21 and begin screening with an HPV test at age 25. You may need screening more often if you: Had an abnormal HPV test, Pap smear, or cervical biopsy in the recent past. Have had a diagnosis of cervical cancer.

Have a weakened immune system. Were exposed to a drug called DES (Diethylstilbestrol) before you were born. Between the years 1940-1971, DES was sometimes prescribed to prevent miscarriages. If you are over age 65 and have had regular Pap smear screenings with normal results, your provider may tell you that you no longer need them.

If you have HIV, you may need to continue screenings after age 65. You don't need cervical cancer screening if you had a total hysterectomy (surgery to remove your uterus and cervix) because of a condition that was not cancer. But if your hysterectomy was related to cervical cancer or precancer, ask your provider whether you need screening. NIH: National Cancer Institute

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