Cervical Cancer Screenings: Pap Tests, HPV Tests and Pelvic Exams

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

Any woman or transgender male who has a cervix (lower part of the uterus) needs to get screened for cervical cancer. For specifics on when you need to get which screenings, see the question below that addresses this issue. 

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.

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: 

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.

If your cervix was removed at the time of your hysterectomy (total or complete hysterectomy), and you had no prior history of precancer or cancer of the cervix, you likely do not need to continue getting cervical cancer screenings. Talk to your gynecologist if you have questions.  

First, don’t panic. HPV is very common and doesn’t usually lead to cancer. In most women who have HPV, their immune system clears the infection from their bodies within a few years. 

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. 

An abnormal Pap test result can mean various things. There’s a wide breadth of abnormal results that people can have. It’s important to talk to your gynecologist or other physician and ask them to help you understand the results and what they mean for you. 

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.