Why Cervical Cancer Screening Matters

Cervical cancer used to be one of the most common causes of cancer death for women in the United States. Today it is far less common, largely because of regular screening. Screening tests find changes in the cells of the cervix years before they could turn into cancer, when they are simple to treat.

Almost all cervical cancers are caused by long-lasting infection with high-risk types of human papillomavirus (HPV). HPV is extremely common and is spread through intimate skin-to-skin contact. Most infections clear on their own within a year or two. The concern is the small share of infections that persist and slowly cause abnormal cell changes. Two types, HPV 16 and HPV 18, cause about 70% of cervical cancers.

This guide explains the tests, how often you need them, what your results mean, and how to prepare.

The Tests: Pap, HPV, and Co-testing

There are three ways to screen:

  • Pap test (cervical cytology): cells collected from the cervix are examined under a microscope for abnormal changes.
  • Primary HPV test: the sample is tested for high-risk HPV types. If HPV is found, the lab or your clinician follows up, often with a Pap test on the same sample.
  • Co-testing: a Pap test and an HPV test are done together on one sample.

For all three, the sample is collected during a speculum exam. The clinician uses a small brush or spatula to gently collect cells from the cervix. It usually takes less than a minute and may feel like pressure or mild cramping.

Self-collection is a newer option. In 2024 the FDA approved HPV tests that use a vaginal sample you collect yourself in a clinic, and in 2025 it approved the first kit for collecting the sample at home. Self-collected samples can only be used for HPV testing, not for a Pap test, and they are not right for everyone, so ask your clinician whether it is an option for you.

How Often Should You Be Screened?

The U.S. Preventive Services Task Force (USPSTF) recommendations for people with a cervix who are at average risk are:

  1. Under 21: no screening, regardless of when sexual activity began.
  2. Ages 21 to 29: a Pap test every 3 years.
  3. Ages 30 to 65: any one of these options:
  • a primary HPV test every 5 years
  • co-testing every 5 years
  • a Pap test alone every 3 years
  1. Over 65: screening can stop if you have had adequate negative screening in the past 10 years and are not otherwise at high risk.

The American Cancer Society recommends a slightly different schedule: starting at age 25 with a primary HPV test every 5 years through age 65, with co-testing every 5 years or a Pap test every 3 years as acceptable alternatives when primary HPV testing is not available. Both approaches are reasonable. Ask your clinician which schedule they follow.

You may need more frequent screening if you have HIV or another condition that weakens the immune system, were exposed to diethylstilbestrol (DES) before birth, have had an organ transplant, or have a history of high-grade precancer or cervical cancer.

After a hysterectomy: if your cervix was removed for a reason other than cancer or precancer, you generally do not need cervical screening. If your cervix was not removed, or the surgery was for precancer or cancer, you may still need testing.

If you have had the HPV vaccine, keep following the screening schedule. The vaccine does not protect against every high-risk HPV type.

How to Prepare for Your Test

A few simple steps can help make sure the sample is easy to read:

  • Try to schedule the test when you are not on your period. Light spotting is usually fine, but call ahead if you are unsure.
  • For two days before the test, avoid vaginal intercourse, douching, tampons, vaginal medicines, spermicides, and vaginal lubricants, unless your clinician tells you otherwise.
  • Tell your clinician if you are pregnant, could be pregnant, or have had abnormal results before.
  • Wear comfortable clothing, empty your bladder beforehand, and ask for a smaller speculum or a pause at any point if you feel uncomfortable.

Remember that a pelvic exam and a Pap test are not the same thing. A pelvic exam does not screen for cervical cancer unless a sample is collected. A Pap test also does not check for sexually transmitted infections, so ask separately if you want STI testing.

Understanding Your Results

Negative or normal: no abnormal cells and/or no high-risk HPV were found. You can return at your regular screening interval.

HPV positive with normal cells: this is common. Depending on your age, which HPV type was found, and your past results, your clinician may recommend repeat testing in one year or a closer look with colposcopy. A positive HPV result does not mean you have cancer, and it does not tell you when or from whom you got the infection.

Abnormal Pap results are reported with abbreviations such as:

  • ASC-US (atypical squamous cells of undetermined significance): mildly unusual cells, often caused by HPV. HPV testing usually guides the next step.
  • LSIL (low-grade squamous intraepithelial lesion): low-grade changes that often go away on their own.
  • HSIL (high-grade squamous intraepithelial lesion): more serious changes that need prompt follow-up.
  • AGC (atypical glandular cells): changes in glandular cells that need further evaluation.

Since 2019, follow-up in the United States has been based on the American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based guidelines. Instead of looking at one result in isolation, your clinician considers your current result together with your history to estimate your risk and choose the next step.

What Happens After an Abnormal Result

Colposcopy is an office procedure in which the clinician uses a magnifying instrument to look closely at the cervix after applying a mild vinegar solution that makes abnormal areas easier to see. Small tissue samples (biopsies) may be taken. You may feel a pinch or cramping, and light spotting afterward is common.

If biopsies show high-grade precancer, it can usually be removed in the office or as a short outpatient procedure, most commonly with LEEP (loop electrosurgical excision procedure). Treating precancer is highly effective at preventing cervical cancer. Follow-up testing afterward is important because changes can come back.

Signs You Should Not Ignore

Screening is for people without symptoms. If you have any of the following, see a clinician even if your last screening test was normal:

  • Bleeding after sex
  • Bleeding between periods or after menopause
  • Unusual vaginal discharge, especially if it is watery, bloody, or has a strong odor
  • Pelvic pain or pain during sex

These symptoms are much more often caused by infections or other non-cancer conditions, but they should be checked.

Prevention Beyond Screening

The HPV vaccine is recommended routinely at age 11 or 12 and can be started as early as age 9. Catch-up vaccination is recommended through age 26. Adults aged 27 to 45 who were not vaccinated can talk with their clinician about whether vaccination makes sense for them. Not smoking and using condoms also lower the risk of persistent HPV infection, although condoms do not fully prevent it.

Frequently Asked Questions

Does an abnormal Pap test mean I have cancer? Almost never. Most abnormal results are caused by HPV-related changes that either go away on their own or can be treated long before cancer develops.

I am in a long-term relationship. Do I still need screening? Yes. HPV can stay in the body for years before causing changes, so a recent positive result does not mean a partner was unfaithful.

Can I be screened while pregnant? Yes. Screening is safe during pregnancy, and some follow-up steps may be adjusted until after delivery.

Do I need screening if I have never had sex with a man? Yes. HPV can be passed through any intimate skin-to-skin contact, so screening is recommended on the usual schedule.

This article is for informational purposes only and is not a substitute for professional medical advice. Talk with your healthcare provider about which screening schedule is right for you.