Pap Smears & HPV Tests
Preventative testing is a powerful tool in the battle against conditions that worsen over time. In this article, we’ll be taking a look at the preventative measures you can take to tackle HPV-related cancers.
The Papanikolaou (Pap) smear is a screening procedure that looks for cancer and precancerous cells in the cervix or colon. A common cause of cell abnormalities is the human papillomavirus (HPV). A test can be used to look for evidence of the virus and to determine which type of HPV it is.
HPV & how it affects us
The human papillomavirus (HPV) is the most common STD, with millions infected worldwide. Most people don’t know when they’ve been infected, as most cases are asymptomatic and resolve on their own. HPV isn’t exclusively an STD as it spreads through skin-to-skin contact but is typically transmitted during sex.
Of more than 150 related viruses, only a few pose a serious threat.
Cutaneous (skin) HPV types: Cutaneous HPV types cause common warts (non-cancerous tumours) on the skin, usually on the hands, feet, arms, and chest.
Mucosal (genital) HPV types: Mucosal HPV types generally infect only mucosal surfaces, such as the genitals, anus, and the lining of the mouth and throat. These can be divided into low-risk and high-risk viruses.
- Low-risk HPVs can cause warts on the genitals and anus in both men and women. HPV 6 and HPV 11 cause about 90% of genital warts, but rarely develop into cancer (chronic or long-lasting infections are more likely to cause cancer over time). These warts can appear in places, like the cervix and vagina, where they aren't always noticed without a proper test.
- High-risk HPVs can cause cervical cancer, along with cancers of the colon, anus, vagina, vulva, penis, and tonsils. This doesn't mean all high-risk HPVs cause cancer, just that certain types of HPV—including types 16 and 18—increase the potential risk.
HPV infections are relatively common in people under the age of 21, and usually resolve themselves without treatment or complications. Because the virus is so common, most people in this age group test positive. However, screening people under the age of 25 is not generally recommended.
Pap smears & HPV tests
The Pap smear (or Pap test) is a screening procedure used to detect cancerous and precancerous cells. The test is named after its inventor—Georgios Nikolaou Papanikolaou (1883–1962). Pap smears and HPV tests can be done separately or at the same time (co-testing). Although they do different things, they both serve the same purpose.
The Pap smear detects abnormal cells in the cervix or colon. Routine testing greatly increases the likelihood of identifying cancer at an early stage, when there is the greatest likelihood of recovery. Pap smears can also identify precancerous cells in the cervix before they develop into cancer. Removing precancerous cells prevents cervical cancer in 95% of cases.
HPV tests are used to detect DNA from HPV cells. If abnormal cervical cells are detected by a Pap smear, an HPV test can determine what type of HPV is present and if it causes cancer.
A speculum is a medical tool a gynaecologist uses to open the vaginal canal to be able to see the cervix directly. To collect cells for either the Pap smear or the HPV test, the speculum is inserted into the vagina and a scraper or brush is used to collect a small sample of cells from the cervix. The collected cells are sent to a laboratory for testing.
Do I need a Pap smear?
Once a woman turns 21, it’s recommended that she get a Pap smear once every three years.
Once a woman reaches 30, having a Pap smear every 3 years can be replaced by having an HPV test (or both tests) every five years. If a woman has reached the age of 65 and has had three consecutive Pap tests showing no abnormal cells, she can stop having the tests.
Regular testing is strongly recommended, even if you are a virgin, have had an HPV vaccine, or have gone through menopause.
Your doctor might suggest more frequent Pap and HPV tests if:
You have had an abnormal Pap result or cervical cancer in the past
Women with a medical history of precancerous cells or cervical cancer may need to be tested more often to ensure that any changes are caught early.
If you are HIV-positive
Women who are living with HIV are at a higher risk of cervical cancer and other cervical diseases. If you are diagnosed with HIV, you should have one Pap test as soon as possible and and another Pap test 6 to 12 months later. After 3 consecutive Pap tests with normal results, people with HIV can go back to having the test every 3 years.
You have a weakened immune system
Whether due to an organ transplant, chemotherapy, or steroid use, if your immune system has been impaired, even a mild HPV infection might not go away on its own.
Your mother was given diethylstilboestrol when she was pregnant with you
Diethylstilboestrol (DES) is a synthetic form of the female hormone oestrogen. Between 1940 and 1971 (until 1978 in some European countries) it was prescribed to pregnant women to prevent miscarriage, premature labour, and related complications.
DES is now known to be an endocrine-disrupting chemical, one of a number of substances that interfere with the endocrine system to cause cancer, birth defects, and other developmental abnormalities.
Getting tested
Pap smears and HPV tests usually take about five minutes. There are a number of things you can do to prepare in order for your test to go smoothly.
Inform your doctor
It is important that your doctor knows what (if any) medications you are taking, including birth-control pills. Some may contain oestrogen or progestin, which can affect the test results. It is also important for your doctor to know if you have had an abnormal Pap or HPV test result in the past.
Avoid sexual intercourse for at least 24 h before your test, as this, too, can interfere with your results. Do not use any spermicidal products and don't douche (douching is not recommended overall). If you are a virgin or a person of smaller stature, you might feel more comfortable if your doctor uses a smaller speculum. Ask your doctor about this before the test.
Plan around your period
Try not to schedule your test on days you might be menstruating. Tests can be done during this time, but the results might not be as accurate.
Make sure to tell your doctor if you are pregnant
In most cases, it’s safe to have a Pap or HPV test until the 24th week of pregnancy. After this, tests may be more painful. After giving birth, wait 12 weeks before getting tested, as results may not be that accurate soon after.
Make sure you feel safe
These tests go more smoothly if you are relaxed. Remember to breathe and try to stay calm. These tests shouldn’t cause pain, but they can be uncomfortable. Some women report feeling a small pinch. However, if you are concerned about feeling pain, you can take over-the-counter pain medication an hour before your test.
If you have been sexually assaulted or experience anxiety that makes having the test difficult, be sure to tell your doctors. They may be able to make the situation more accommodating to you.
If you notice some spotting afterward, don't panic—it's usually nothing to worry about. However, if the bleeding persists, you should talk to your doctor.
Test results
It usually takes 1 to 3 weeks to get the test results. There are three possibilities:
Negative/normal results: Only normal cervical cells were found during your test. You won’t need any other treatment or testing until your next Pap test or pelvic exam.
Unclear: The test has not determined whether the cells collected from your cervix are normal or abnormal. If the results are unclear, your doctor may want to have more testing done right away or may ask you to come back in 6 to 12 months.
Positive/abnormal results: If abnormal or unusual cells are found, further testing may be required. The presence of abnormal cells does not necessarily mean you have cervical cancer, but you may be at risk if one of the dangerous types of HPV is found in your system.
If 3 weeks have passed and you haven’t heard from your doctor's office, call to inquire about your test results.
If you’ve tested positive
If your test results show a mild infection, your doctor may recommend a repeat screening in a year. If the test detects severe changes or evidence of cancerous cells, your doctor might recommend a colposcopy.
The procedure usually takes about 15 minutes and is similar to a pelvic exam—the doctor inserts a speculum into the vagina in order to widen it and see the cervix. A weak vinegar or iodine solution is sometimes applied to the cervix to make the abnormal cells more visible. The solution may cause a burning or tingling sensation.
A small tissue sample may be collected for laboratory testing. This procedure is called a biopsy. If more than one area looks suspicious, multiple biopsies may be taken for examination.
The results of your colposcopy will determine if you need additional tests and treatments.
Squamous cell abnormalities
Squamous cells are thin, flat cells that make up the epidermis—the outermost layer of the skin. Squamous cell abnormalities are divided into the following groups:
Atypical squamous cells (ASC) are the most common abnormal finding in Pap smears:
- ASC-US: atypical squamous cells of undetermined significance. The cells do not appear completely normal, but the cause is unclear. The changes may be related to an HPV infection, but they can also be caused by other factors.
- ASC-H: atypical squamous cells with high-grade lesions that cannot be excluded. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions.
A squamous intraepithelial lesion (SIL) is an abnormal growth of squamous cells. These are divided into low-grade and high-grade SILs:
- Low-grade squamous intraepithelial lesions (LSILs) are considered mild abnormalities caused by an HPV infection. LSILs often return to normal as the immune system controls the infection, especially in younger women.
- High-grade squamous intraepithelial lesions (HSILs) are more severe abnormalities that have a higher likelihood of progressing to cancer if left untreated.
Carcinoma in situ (CIS) refers to severely abnormal cells that resemble cancer cells but have not spread into or beyond the cervix.
Squamous cell carcinoma (SCC) also called epidermoid carcinoma, is a cancer that begins in the squamous cells.
Glandular cell abnormalities
Glandular cells are found in the cervix and the lining of the uterus. Glandular cell abnormalities are abnormal changes that occur in the glandular tissues of the cervix.
Atypical glandular cells (AGC) are glandular cells that do not appear normal, but the significance of the abnormality is unclear. Endocervical adenocarcinoma in situ (AIS) refers to severely abnormal cells that have not spread beyond the glandular tissue of the cervix.
Adenocarcinoma is a cancer that begins in glandular cells. The term includes not only cancer in the endocervical canal, but may also include endometrial, extrauterine, and other cancers.
We all lead busy lives, and it’s all too easy to write off our aches and pains as inconveniences to be ignored, much less search for conditions that don’t make themselves known. However, regular check-ups can be the difference between a close call and stage 4 cancer.
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