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Screening for cervical cancer
Screening means checking or testing for a disease in a group of people who don’t show any symptoms of the disease. Screening tests help find cervical cancer before any symptoms develop. When cervical cancer is found and treated early, the chances of successful treatment are better.
In Canada, screening for cervical cancer using the Pap test has successfully reduced the number of women who develop cervical cancer and die from it. Talk to your doctor to learn more about your personal risk for cervical cancer and how you can take advantage of screening tests or programs.
Know what puts you at high risk
All women should follow the screening guidelines for cervical cancer and talk to their doctor about when they should have screening tests.
Some women have a higher than average risk of developing cervical cancer. You may be at higher risk if you have:
- a weakened immune system
- been exposed to diethylstilbestrol (DES) before birth
- constant infection with high-risk types of human papillomavirus (HPV)
- genital warts that are long-standing or difficult to treat
- cancers related to HPV such as cancer of the anus or vulva
Your immune system can be weakened if you take drugs to suppress it after an organ transplant. It can also be weakened if you have human immunodeficiency virus (HIV) or systemic lupus erythematosus (SLE). Using corticosteroids for a long period of time can also weaken your immune system.
Talk to your doctor about your risk. If you are at higher than average risk, you may need a personal plan for testing. This may include:
- having Pap tests more often
- HPV test
Who should have Pap tests
All women who have been sexually active should have regular Pap tests by the time they are 21 years of age. This includes:
- women who have had the human papillomavirus (HPV) vaccine
- women who have sex with men or women
- women who have stopped having sex
- women who have had a partial hysterectomy and still have a cervix
- trans men who still have a cervix and are sexually active
A Pap test is done every 1–3 years, depending on the provincial or territorial screening guidelines and your previous test results.
Women who have never been sexually active and women who have had a total hysterectomy should talk to their doctors about whether or not they need to have regular Pap tests. Pap tests are usually continued after a total hysterectomy if it was done to treat a precancerous condition or cancer. Find out more about hysterectomy.
Women older than 69 should talk to their doctors about whether or not they need to have regular Pap tests. The decision to stop is often based on a woman’s history of having normal, or negative, Pap test results.
Trans women who have had bottom surgery and who are sexually active should talk to their doctors about having Pap tests or other vaginal tests to screen for cancer. Doctors can help trans women and trans men determine how often they need a Pap test based on their health and surgical history.
Screening programs in Canada use the Pap test to find cervical cancer early. Sometimes the HPV test may be used along with the Pap test to screen for cervical cancer.
During a Pap test, a healthcare professional collects a small sample of cells from the cervix. The cells then get looked at under a microscope to see if there are any abnormal changes. A Pap test is the main tool used to screen for cervical cancer because it can find changes to cervical cells early, before cancer develops.
The HPV test may be done on the same sample of cells used for the Pap test or on a sample collected separately. It may also be used as a follow-up test after an abnormal Pap test result. An HPV test looks for HPV DNADNAThe molecules inside the cell that program genetic information. DNA determines the structure, function and behaviour of a cell. in cells taken from the cervix. The test can tell you if the type of HPV is high risk, which means it can cause precancerous changes in the cervix.
The HPV test is available in Canada, but not in all provinces or territories. The HPV test is used only for women 30 years of age and older. It is not appropriate for women younger than 30 because temporary HPV infections are very common in this age group. These infections are unlikely to result in abnormal cervical changes that could lead to cancer.
Most provinces and territories have organized cervical screening programs, each with specific guidelines. Although the guidelines may differ, all programs include regular Pap tests to help find cervical cancer early.
How to join a screening program
Cervical cancer screening is available to Canadian women through their family doctor, a cervical cancer screening program, women’s health clinics or public health units. Check with your doctor or your provincial or territorial screening program for details about cervical cancer screening programs in your area.
You can also call the Canadian Cancer Society’s Cancer Information Service toll-free at 1 888 939-3333 for information about cervical cancer and screening programs.
What happens after screening is done
After you have a screening test, your doctor or the trained healthcare professional sends the cervical cell samples to a laboratory. The screening program will send the results to your doctor. Some programs will also send the results to you. Your doctor will decide if more tests, treatment or follow-up is needed. The screening program will also send a reminder to let you know when your next Pap test is due.
Follow-up after screening
If a Pap test shows a change or abnormality, you may need follow-up tests. Tests done as part of follow-up may vary depending on the Pap test results. Follow-up tests may include:
- another Pap test
- HPV test
- colposcopic biopsy
- endocervical curettage
- endometrial curettage
- cone biopsy
Some changes or abnormalities may not require treatment, depending on how severe they are. Some women may need to have the following to treat a change or abnormality:
- laser surgery
Questions to ask your healthcare team
To make the decisions that are right for you, ask your healthcare team questions about screening.