Cervical Cancer Screening: Pap, HPV Test, and When to Start

Medically reviewed by Dr Darshana Ajmera — Obstetrician, Gynaecologist & Fetal Medicine Specialist, Shubham Hi-Tech Hospital.

Most women who have never had a cervical screening are not careless. They are busy, or embarrassed, or quietly afraid it will hurt, and above all they feel fine. “Why look for a problem I don’t have?” is the question I hear most often. It is a fair one, and the answer is the most hopeful thing I can tell you about cancer: with the cervix, we can find the trouble years before it becomes cancer, and treat it simply.

Why screening matters even when you feel perfectly well

Cervical cancer is caused by long-standing infection with high-risk types of the human papillomavirus (HPV). It is a very common virus, and most infections clear on their own. When one does not, it can slowly change the cells of the cervix. That journey from infection to pre-cancer to cancer usually takes many years, and the early stages cause no pain, no bleeding and no discharge. Symptoms tend to appear only late.

In India this matters. Cervical cancer causes more than 1,20,000 new cases and roughly 80,000 deaths a year (GLOBOCAN 2022), and HPV types 16 and 18 are behind over 80% of cases here. Screening exists to interrupt that slow journey while it is still easy to treat.

Pap test, HPV test: what each one looks for

Both tests use a sample taken from the cervix in a few seconds. They ask different questions.

• Pap smear (cytology): are the cervical cells already looking abnormal under the microscope?
• HPV test: is the high-risk virus that causes those changes present at all?

Sometimes we do both together, which is called co-testing. You may also hear about VIA (visual inspection with acetic acid), a quick visual check used in many public health programmes. Which one suits you depends on your age, your history and what is available.

“I have no symptoms and nobody in my family has had cancer. Surely I can skip it?”

I understand the logic, but this cancer does not run in families the way some do. It follows the virus, and the virus is common. The whole point of screening is that you feel well while we look.

When to start, and how often

Guidelines differ a little between countries, and I tailor advice to each woman. The pattern most commonly followed is this:

• Many international guidelines begin Pap testing around age 21 and repeat it every three years. India’s national programme and the WHO focus on women from about 30.
• From 30 to around 65, an HPV test every five years is widely used. A Pap every three years, or both together every five, are also accepted.
• You may need to be screened more often if you have HIV or are on medicines that lower immunity, have had an abnormal result before, or have had treatment on the cervix.
• Screening can usually stop around 65 if your recent results were normal, and is not needed after a hysterectomy that removed the cervix for a non-cancer reason.

A quick self-check: is it time for you to book?

• You are 30 or older and have never been screened
• Your last Pap smear was more than three years ago, or your last HPV test more than five
• You had an abnormal result before and never went back
• You have a weakened immune system
• You are vaccinated against HPV but have not been screened (vaccination does not replace screening)

If you tick even one, a short visit is worth your time. And if you are over 30 and have never been screened, today is a perfectly good day to start. It is never too late to begin.

What to expect at your appointment

It is quicker and gentler than most women expect. Here is how it goes:

1. Timing. Book it when you are not menstruating. For a day or two before, avoid intercourse, vaginal creams and douching, which can blur the sample.
2. Talk first. We ask a few questions and you can ask yours. Nothing starts until you are ready.
3. The examination. You lie back, and a smooth, lubricated instrument called a speculum gently opens the vagina so the cervix can be seen.
4. The sample. A soft brush collects cells from the cervix. You will feel pressure, perhaps a brief cramp. It takes seconds.
5. After. You can go straight back to your day. Light spotting can happen. Results usually take from a few days to a couple of weeks.

“I’ve heard it’s awful. What if I can’t relax?”

This is the most common worry, and it is manageable. Tell us. A smaller speculum, a slower pace, a pause when you ask, and a gentle word or two make a real difference. You are always in control of the examination.

Myth versus fact

Myth: Only women with many partners need screening.

Fact: HPV is so common that most sexually active people meet it at some point. Screening is for every woman in the age group, whatever her history.

Myth: A positive HPV test means I have cancer, or that my partner has been unfaithful.

Fact: HPV can stay quiet in the body for years, so it says nothing reliable about when it was acquired. A positive test means we watch more closely. It does not mean cancer.

Myth: After menopause I no longer need it.

Fact: Screening continues until around 65, depending on your previous results.

If a result is not normal

An abnormal result is common, and it is not a diagnosis of cancer. Usually it means one of three things: repeat the test after a short interval, take a closer look at the cervix with a magnifying instrument (colposcopy), or take a tiny sample for the laboratory. Pre-cancerous changes can often be treated in a simple procedure before they cause any harm. We explain each step, and nothing is done without your say.

A short invitation

If you have never been screened, or cannot remember when you last were, please do not put it off another year. The gynaecology and obstetrics team at Shubham Hi-Tech Hospital in Amravati is happy to do a screening in an unhurried visit and explain your result in plain words. Call +91-8668954915, reach us through our contact page, or read about our obstetrics and gynaecology services.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.