Pap Test, Cervical Cancer Screening, HPV Category, Risk Involved

Pap test (or Pap smears) can detect cervical cancer and early lesions. Precancerous diseases are cellular changes that can be caused by human papillomavirus (HPV). If left untreated, these abnormal cells can cause cervical cancer. HPV testing looks for HPV in cervical cells. Most women between the ages of 21 and 65 require a Pap test or Pap test and HPV at the same time. Not all women need to undergo an examination every year.

What is a Pap Test?

Pap test is a test performed by a Gynecology consultant or nurse to check the cervix for abnormal cells. The lower part of the cervix (uterus) that opens into the vagina. If abnormal cells in the cervix are not detected and untreated, it can lead to cervical cancer.

During a Pap test, the doctor or nurse inserts a detector (a device that helps your doctor or nurse look at your cervix) into the vagina and collect cells from outside your cervix. Uses a stick or soft brush. These collected cells are then sent to a laboratory for testing purposes.

What is an HPV Test?

The HPV test looks for HPV DNA in the cells of the cervix. The cervix is the lower part of the uterus (uterus) that opens into the vagina. HPV is a sexually transmitted infection (STI) that clears up on its own in most people. If it persists, HPV can cause abnormal cells in the cervix that can lead to cervical cancer.

An HPV test can screen out if anyone is infected with HPV. There are many types of HPV strains but only certain types of HPV strains are more likely to cause cervical cancer.

During an HPV test, the doctor or nurse inserts a dilator (an instrument that helps the doctor or nurse see your cervix) into the vagina and uses a soft brush to collect cells from the outside of the cervix opening area.

Pap tests and HPV tests can be done at the same time (this is called co-testing).

Why is there the need to take a Pap and HPV test for every woman?

A PAP test can save a life. It can detect cervical cancer cells at an early stage. If this disease is detected soon, then the chances of successful treatment of cervical cancer are very high. Pap tests can also detect abnormal cells in the cervix before they become cancerous. Overcoming these precancerous conditions prevents cervical cancer in over 95% of cases.

An HPV test can give doctors more information about the cells in the cervix. For example, if a Pap smear shows abnormal cells in the cervix, an HPV test can show if you have a type of HPV that causes cervical cancer.

Which category of women should get tested for Pap and HPV regularly?

Most women between the ages of 21 and 65 are required to undergo a Pap test as part of their regular health care. Even if you are not currently sexually active, have received an HPV vaccine, or have gone through menopause, you still need sweet spears regularly. Expert advice: 

• 21-29-year-old women smear pap every 3 years.
• Women 30–65 years old receive:
• Pap test every 3 years or
• HPV test every 5 years, or
• Conducting a Pap smear and HPV (called joint testing) every 5 years.

Women over 65 years of age require a Pap smear if they have never been tested or tested after the age of 60.

HPV testing is recommended for women of  30 years and older. Although HPV is common in women under 30 years, it usually goes away on its own in these women. A Pap test with an HPV test alone or HPV test alone is most helpful for women 30 and older.

Which age category of women should not require Pap and HPV test?

Only women may not need regular Pap tests or HPV are :

• Women over 65 years of age, who have had three normal Pap tests or two normal combined tests (with HPV) in a row in the last 10 years, and the last test is done within the last 5 years and being told by their doctors that they need not require to test again.
• Women who do not have a cervix (usually due to hysterectomy) and have no history of cervical cancer or abnormal pap smears

Who needs Pap and HPV tests more often?

Consultant Gynecology doctor or nurse may recommend Pap tests and HPV tests more often to :

• In the past, you have been treated for abnormal pap test results or cervical cancer. Women with a history of precancerous cells or cervical cancer may need to be screened more often because their medical history puts them at greater risk in the future.
• Women who are infected with HIV. Women living with HIV (the virus that causes AIDS) due to a weakened immune system are at greater risk of cervical cancer and other cervical diseases. All women living with HIV should have one primary Pap smear, 12 months after HIV is detected and another Pap smear (or Pap and HPV if you are over 30). Some experts recommend a second Pap test or Pap test and HPV test after 6 months, so talk to your doctor or nurse. After three normal Pap tests in a row, a follow-up Pap test may occur every 3 years in women living with HIV.
• If any mother was exposed to diethylstilbestrol (DES) during pregnancy. Daughters and possibly granddaughters of women taking DES during pregnancy have a higher risk of cervical cancer and some other types of cancer. 
• Women having weakened immune systems with organ transplants, chemotherapy, or steroid use. HPV cannot go away on its own in a person with a weakened immune system.

What is the turnaround time of the Pap and HPV tests?

It usually takes 1 to 3 weeks for a Pap smear and HPV test result. In most cases, the test results are normal.

Can Pap or HPV test be taken during the period?

Yes, you may have a Pap test or HPV test during your period. It is better to schedule an exam at a time when your period is not expected.

What do Pap Test Results mean?

The results of your Pap test indicate one of the following three:

• Normal: During the pap test, the cells cut from the cervix should look the way they look and you don’t need to do anything until the next pap test.
• Unclear: Your doctor does not know if the cells taken from the cervix are normal or abnormal. If the results are not clear, your doctor may immediately conduct additional tests to detect any problems, or your doctor may ask you to return after another 6 months or a year for another Pap test.
• Abnormal: Cells collected from the cervix look abnormal during a Pap test. An abnormal pap smear result does not mean you have cancer, so your doctor should do other tests to find out what should happen next. Your doctor may take another Pap test immediately, or if the cell changes are minor, then wait 6 months or a year before taking another Pap test. If the test detects more severe changes in cervical cells, your doctor will perform additional tests, such as colposcopy and biopsy.

What is a colposcopy test?

During a colposcopy, the doctor carefully examines abnormal areas of the cervix and uses a device with a light and a magnifying glass (called colposcope) to make them easier to see. A doctor may apply a small amount of vinegar to the cervix to uncover abnormal areas.

If there is an abnormal area on the cervix, the doctor will perform a biopsy (sample the tissue from the cervix) to examine the cancer cells. The results of these tests will help doctors choose the best treatment.

What is the reason for “unclear” or “abnormal” Pap test results mean?

A Pap test can be “unclear” or “abnormal” for several reasons. Most often, abnormal cellular changes are caused by HPV. HPV is an STI that can give rise to cervical cancer.

Other reasons may result in your “unclear” or “abnormal” Pap test results: 

• Infection, such as a fungal infection, or inflammation.
• Benign neoplasm or ulcer (not cancerous)
• Hormone changes, such as during pregnancy or menopause
• Smoking, which may increase the risk of HPV infection developing into cervical cancer. 
• Problems with your immune system due to certain medications or health problems such as diabetes, cancer, HIV, or autoimmune diseases.

What do HPV test results mean?

• The HPV test result will tell if anyone women have HPV and what type it is. Researchers know of a dozen HPV types out of more than 200 that can cause cervical cancer.
• HPV test results are usually given along with Pap smear results. Running two tests simultaneously (called simultaneous testing co-testing) can help the doctor to understand if you need to be tested more often or if you need different tests.
• If you do not have HPV and the results of your Pap smear are normal, you can wait up to 5 years before retiring.

Any type of risk involved during the Pap test?

Yes. Although Pap tests are very safe, they have their limitations.

• Pap testing may fail to detect abnormal cells that actually exist. This means that your doctor can tell you that your cervical cells are normal, but the test misses a cell problem. This can delay the detection and treatment of abnormal cells in the cervix. But having a Pap test regularly increases your chances of developing problems. Cervical cancer usually develops over several years – 10 to 20 years on average. If abnormal cells are not found in your Pap smear, your doctor or nurse will likely find them on your next Pap test. Therefore, it is important to have a Pap test in the recommended schedule based on your age and medical history.
• Pap smear results can reveal abnormal cells that are not actually present. This means that your doctor can tell you that your cervical cells are abnormal, but in fact they are normal. It is impossible to know if the cells are normal without further testing. Therefore, your doctor may do another Pap test or other tests to find out more. If your next Pap test or other test becomes normal, then you do not need to do anything until your next Pap test is scheduled.

(Disclaimer: Information provided in this piece of article is purely for educational purposes only. All results must be clinically correlated with the patient’s data to make an accurate diagnosis.) 

References :

1. National Cancer Institute (Internet), Bethesda (MD), U.S Department of Human Health Services. HPV and PAP Testing.
2. Office of Population Affairs (Internet). Southwest Washington DC: United States Department of  Human Health Services. Cervical Cancer Screening (Pap Test).
3. Center For Dieses Control And Prevention (Internet), Atlanta GA; US Department of Human Health Services; What Should I Know About Screening.