Cervical Cancer Screenings: Pap Tests, HPV Tests and Pelvic Exams
Physicians and scientists now know that the human papillomavirus virus (HPV) causes most cases of cervical cancer in women. This discovery has led to changes in how women are screened for cervical cancer.
Women now get HPV tests in addition to Pap smears. Both tests can be conducted as part of a pelvic exam. Your gynecologist collects cells from the cervix, which are then analyzed in a laboratory. The pelvic exam itself is also an important cancer detection tool. Your gynecologist will look and feel for signs of various gynecological cancers during the exam — not only cervical cancer, but also ovarian, uterine, vaginal and vulvar cancer.
The goal of cancer screening is to identify precancerous tissue changes or early-stage cancers that can be treated before they become advanced. Thanks to screening tests and tools, the number of women who get cervical cancer or die from the disease has decreased dramatically.
Yet many women aren’t sure when and how often they need to see a gynecologist for cervical cancer screenings. Some women think they need a Pap smear every year. Others believe they only need to see their gynecologist every three or five years. Then there are women who have gotten the human papillomavirus (HPV) vaccine, which offers significant protection against cervical cancer. Do these women even need to get screenings?
All this confusion is understandable. Screening guidelines have been updated frequently in recent years to reflect the latest scientific evidence.
“Complicated,” is how UChicago Medicine gynecologist Shivika Trivedi Kapadia, MD, describes the screening guidelines for cervical cancer. For women looking for simple instructions to follow, Dr. Trivedi provides the following advice:
UChicago Medicine, along with the American College of Obstetrics and Gynecology, recommends an annual well-woman exam with a gynecologist for all women of reproductive age. The inclusion of a pelvic exam at this visit should be a shared decision between the patient and the gynecologist, after reviewing each patient’s personal history, symptoms, and risk for infections or cancer.
During a pelvic exam, your gynecologist can conduct any cervical cancer screening tests that you are scheduled to get (for example, a Pap smear and/or an HPV test). In addition, during the same appointment, your gynecologist will likely also conduct a clinical breast exam to feel for lumps and other signs of cancer. You can also get a referral for a mammogram, if you need one.
In the following Q&A, Dr. Trivedi provides more detailed information specifically about cervical cancer screenings.
Frequently Asked Questions About Cervical Cancer Screenings
Almost all cases of cervical cancer are caused by an HPV infection. The virus also causes cancers in the vagina, vulva, mouth, throat and anus (as well as the penis in men). There are many different types of HPV. Some high-risk types — including HPV 16 and 18 — are strongly linked with cervical and other types of cancer.
The HPV virus is sexually transmitted. The CDC estimates that nearly all sexually-active people will get HPV at some time in their life if they are unvaccinated. Typically, a woman’s immune system can fight the infection. But if the virus remains, prolonged exposure can lead to abnormal cell growth, leading to cancer.
Getting an HPV vaccine can greatly reduce the risk of getting cervical cancers as well as other cancers linked to HPV. Boys and girls can be vaccinated as early as 9 years old. Vaccination is recommended for everyone up to the age of 26, and women can get an HPV vaccine up to the age of 45.
Other risk factors for cervical cancer include:
- Being born to a mother who took diethylstilbestrol (DES), a hormone drug used from 1940 to 1971 to prevent miscarriage
- Having a family history of cervical cancer
- Smoking
- Having a weak immune system
- Having had three or more full-term pregnancies
Please note: It’s also important to consider your whole health — not just your risk of getting cervical cancer. Talk with your gynecologist about your personal risk for all cancers that affect female reproductive parts, such as ovaries, vagina, vulva and breasts. Together, decide how often and when you need to see your gynecologist for a health checkup and for various cancer screening tests and exams.
UChicago Medicine, along with the American College of Obstetrics and Gynecology, recommends an annual well-woman exam with a gynecologist for all reproductively aged women. The inclusion of a pelvic exam at this visit should be a shared-decision between the patient and the gynecologist, after reviewing each patient’s personal history, symptoms and risk for infections or cancer.
Two tests — Pap smears and HPV tests — are currently available to screen for cervical cancer. Your doctor may be able to conduct both tests at once (known as an HPV/Pap co-test), if it is indicated. A pelvic exam by a gynecologist is also an important tool in detecting cervical cancer as well as other cancers and infections.
See the table below for more information on these screening tests and exam. Some of these are used to screen for other types of cancers and health problems, too.
| Test or exam | Used to detect what disease(s) and problem(s) | What to expect |
| Pelvic exam |
|
Your gynecologist will examine your cervix as well as other pelvic areas (uterus, ovaries, vagina, vulva, rectum) to identify possible abnormalities, including signs of cancer. The exam will likely include having a speculum (a device shaped like a duck’s bill) inserted into the vagina to allow for visualization of the cervix, followed by a bimanual exam to evaluate the size and shape of the uterus and ovaries. |
| Pap smear (or Pap test) | In addition to identifying precancerous or cancerous cells, Pap tests can also pick up certain infections. | During a pelvic exam, your gynecologist will gently scrape cells from your cervix using a small brush. Once collected these cells will be sent to a laboratory for analysis. |
| HPV test | HPV, which is the number one cause of cervical cancer. HPV can also cause other cancers, including cancers of the vagina, vulva, mouth, throat and anus. |
The HPV test can be completed during a pelvic exam. Your doctor will swab the cervix to collect cells that can be tested for the presence of HPV. When done by itself, this test is known as a “primary HPV test.” |
| HPV/Pap co-test | HPV infection as well as precancerous or cancerous cells. | This co-test allows the laboratory to test the same sample of cells from your cervix for both HPV and cancer. |
At UChicago Medicine, our gynecologists can talk to you about the most recent updates to cervical cancer guidelines. We can help women identify a screening schedule that takes into account their risks for cervical cancer as well as their personal preferences and the latest scientific evidence.
At UChicago Medicine, our gynecologists follow the endorsements of the American Society of Colposcopy and Cervical Pathology (ASCCP) related to cervical cancer screenings.
As of November 2021, ASCCP has endorsed the 2018 guidelines from the U.S. Preventative Services Task Force (USPSTF). These guidelines specify the following for women at normal risk for cervical cancer:
| Under age 21 | No screening necessary |
| Ages 21 to 29 | Get a Pap smear every 3 years |
| Ages 30 to 65 |
Follow one of these approaches:
Talk to your gynecologist about which test approach is available and preferred for you. |
| After age 65 | No testing necessary if you’ve had normal tests at the appropriate frequency up until now |
Please note the following:
- For women at high risk of cervical cancer: The 2018 USPSFT guidelines cited above do not cover women who are considered at high risk of cervical cancer, including women who are HPV positive or immunocompromised or women whose mothers took diethylstilbestrol (DES) during their pregnancies. The guidelines also do not cover women with a history of precancerous lesions in the cervix or with a history of cervical cancer.
- If this describes you, talk to your gynecologist or oncologist about how often you need to get screening and which screening tests you need to get.
- At UChicago Medicine, we offer world-class care for women with cervical and other types of gynecologic cancers, including the support you need to optimize your current and future health needs.
- In 2020, the American Cancer Society (ACS) released updated guidelines for cervical cancer screening. The new ACS guidelines emphasize starting HPV screening earlier, at age 25 rather than waiting until age 30. ACS also promotes the use of the primary HPV test (by itself) rather than the Pap/HPV co-test or Pap by itself. This heightened focus on HPV testing in the ACS guidelines reflects the growing recognition that HPV causes most cases of pre-cancer and cancer of the cervix.
- ASCCP has voiced its support for the 2020 ACS guidelines.
The HPV vaccine provides excellent protection against cervical cancer, as well as other cancers caused by HPV, such as vaginal and vulvar cancers. However, it does not provide 100% protection. For this reason, women still need to get regular cervical cancer screenings and pelvic exams even if they’ve been vaccinated for HPV.
Of note, the complete HPV vaccination series consists of two shots if started before age 15, or three shots if started after the age of 15.
To ensure any cancer is caught early, your gynecologist may recommend repeating the HPV test and/or a Pap test. When any abnormalities are suspected, you may need to undergo additional diagnostic tests, such as a biopsy.
You may need to have follow-up tests to uncover more information, including additional HPV or Pap tests or possibly other diagnostic tests, such as a biopsy.
At UChicago Medicine Comprehensive Cancer Center, we have assembled a team — including gynecologic oncologists, radiation oncologists and plastic and reconstructive surgeons — who are highly experienced in diagnosing and treating all types of gynecologic cancers, including cervical cancer.
You can schedule a cervical cancer screening test with a UChicago Medicine gynecologist or primary care provider, such as a family medicine physician. Our experts practice at several convenient locations throughout the Chicago region, including in Northwest Indiana.
We offer a few ways to schedule an appointment:
- Schedule an appointment online through MyChart.
- Call UCM Connect at 1-888-824-0200 to speak with a referral counselor who can help you schedule an appointment.
- Complete the appointment request form at the bottom of this page and a referral counselor will respond to schedule an appointment.
Request an Appointment
To speak to someone directly, please call 1-888-824-0200. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.
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