Women's Health

Pap Smears and Cervical Cancer Screening

NetWellness experts receive many questions on pap smears and cervical cancer screening. Cervical cancer, like all other cancers, develops when the normal process of cell division goes awry. Normally, cells are constantly dividing and dying ensuring that there is a balance between cell death and cell division. A tumor forms when new cells grow out of control because they have lost their ability to turn of the switch that tells them to grow or when old cells are not destroyed and disposed of by the body.

Non-cancerous tumors (benign) are generally not life threatening. This is because they do not usually invade surrounding tissue and spread, are easily removed, and do not tend to grow back after removal. Cancerous tumors (malignant) can be life threatening. This is because they can invade normal tissue, often spread, can be difficult or impossible to remove, and have a stronger tendency to grow back after being removed.

Risk Factors

Research tells us that some factors have been isolated that put you at higher risk to develop cervical cancer. These are:

Human papillomavirus: Human papillomavirus (HPV) infection is the main risk factor for cervical cancer. HPV is a virus that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause cervical cancer, and other types cause genital warts. Doctors may check for HPV even if there are no warts or other symptoms.

Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells and can help to determine if you have the HPV virus. Treating precancerous cervical changes often prevents cancer.

Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system, such as steroids, have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.

Age: Cancer of the cervix occurs most often in women over the age of 40. Although, the infection with the HPV virus usually occurs in teenage and young adult women.

Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection.

Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.

Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection. This may be related to the use of birth control pills without the use of condoms that would protect against the HPV virus.

Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection. This may be related to the use of birth control pills without the use of condoms that would protect against the HPV virus.

Diethylstillbestrol: Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other cancers of the reproductive system in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)

Screening Saves Lives

The good news about cervical cancer is that it can be prevented if abnormal cervical cells are detected early on (before they become cancer) Also, as with any form of cancer, chances of surviving the disease go up when it is detected early and treatment is started right away. Another piece of good news is that the test to screen for cervical cancer, called a Pap smear, is quick, easy, and part of your regular annual women's health exam (also called a pelvic exam).

Screening Guidelines

Age 18: Once a young woman has become sexually active in any way and/or has reached the age of 18 she should start visiting a women's health care provider such as a nurse midwife, nurse practitioner, family physician, or gynecologist to receive annual exams.
Age 21: Pap tests should start when a woman turns age 21 or three years after first intercourse.

Pap Test

A Pap test is simple, quick, and painless; it can be done in a doctor's office, a clinic, or a hospital. Clinicians and healthcare providers 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. While a woman lies on an exam table, the clinician inserts a speculum into her vagina to widen it. A sample of cells is taken from the cervix with a plastic spatula and a small cervical brush. The specimen (or smear) is placed in a liquid container and is sent to a laboratory for examination.

Many doctors are now routinely checking HPV on Pap cells. If a woman over age 30 who is low risk for cervical cancer has a normal pap test and tests negative for HPV, she may not need a repeat pap test for three years. Pap tests are still recommended annually for women under the age of 30.

Abnormal Pap Test Results

Many women have had the experience of receiving abnomal results from their Pap test. This is common and does not necessarily mean that the abnormal cells that have been detected are cancerous or pre-cancerous. Doctors routinely check HPV on abnormal pap results. If you test negative for HPV, it is unlikely that you have cervical cancer, and you will need to repeat your pap test in one year. If you test positive for HPV, you will need to see a specialist for further testing.

The Pap test, although an incredibly helpful tool for preventing and detecting cervical cancer, is not infallible. Sometimes the test will give false positives or negatives. In order to help prevent receiving incorrect test results, follow these 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.

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Last Reviewed: May 05, 2011

Esa M Davis, MD, MPH
Adjunct Assistant Professor of Family Medicine
School of Medicine
Case Western Reserve University

Shazia Ahmed Khan, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University