Cervical Cancer Screening
Ages and intervals for Pap tests and HPV tests
- Screening can find cell changes in the cervix before they turn into cancer.
- "I've had the vaccine," "I've never had penetrative sex," "I'm no longer sexually active" or "I've gone through menopause": none of these is a reason to skip screening.
- When to be screened depends on your age. It does not depend on whether you are married or whether your periods have stopped.
- The type of test and how often it is repeated depend on your age and medical history.
- From ages 21 to 29, a Pap test (Pap smear; in the UK, a smear test) is done every 3 years.
- From ages 30 to 65, primary HPV testing (an HPV test on its own) is done every 5 years.
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When should you have cervical cancer screening?
Screening is done while you still have no symptoms. It can find cell changes in the cervix before cancer develops. These changes usually develop slowly, over a long time, after a persistent infection with human papillomavirus (HPV). This long gap leaves time for follow-up.
How is screening different from diagnosis?
Screening is for people without symptoms. Diagnosis begins when a test result is abnormal or when there are symptoms. If your result is abnormal or you have symptoms, the next step is explained on our cervical cancer diagnosis page.
Pap test, HPV test or both together (co-testing): which is better for you?
Which test is chosen depends mostly on your age and medical history. Below, you can see how the three methods differ and when each one is used.
HPV test
It checks for high-risk types of HPV. Between the ages of 30 and 65, it is usually done every 5 years.
Pap test (cytology)
It looks for changes in the cells of the cervix. Between the ages of 21 and 29, a Pap test on its own is the first choice and is done every 3 years.
Co-testing: a Pap test and an HPV test together
With this method, both tests are done on the same sample. Between the ages of 30 and 65, co-testing is one of the alternative options and is done every 5 years.
Why might your schedule differ?
Starting age and the interval between tests vary from country to country. This depends on each country’s health programme and on your own circumstances; the table above is a general guide.
Cervical cancer screening schedule
Under 21
Screening not recommended
Ages 21 to 29
Pap test (cytology)
Every 3 years
Ages 30 to 65
Primary HPV test
Every 5 years
Ages 30 to 65, alternative option
Co-testing (Pap + HPV) or Pap test alone
Co-testing every 5 years; Pap test alone every 3 years
Over 65
Screening can stop (if past screening was adequate and normal)
People with a weakened immune system or HIV
HPV test, starting earlier
Usually from age 25, every 3 to 5 years
Why might your schedule be different?
The starting age and screening interval are not the same in every country. The differences depend on each country’s health program and on individual circumstances. The table above is a general guide.
Self-collection: a new way to take a sample for an HPV test
You take the sample yourself
If self-collection (in the UK, self-sampling) is offered where you live, you can use a special swab or brush to take a sample from inside your vagina and send it to a lab for an HPV test. No internal exam is needed at this stage. Before you do this, ask your doctor or the lab whether they accept this kind of sample.
Who is it for?
For people who are afraid of an internal exam, feel uncomfortable with it, or cannot easily see a doctor. The aim is to make screening easier for people who skip it for these reasons.
Important points and limits of self-collection
- The sample is taken from inside the vagina, not from the cervix.
- If HPV is found (a positive result), the next step is to see a doctor for an exam and further checks. Self-collection only makes the first step easier; it does not replace the exam that follows.
- Self-collection is usually repeated more often, every 3 years, compared with every 5 years for a test where the doctor takes the sample.
How is a Pap test done, and does it hurt?
- You lie on an exam table. The doctor uses an instrument called a speculum to hold the walls of the vagina open so the cervix can be seen.
- A sample of cells is taken from the surface of the cervix with a soft brush or spatula.
- The sample is sent to a lab. Collecting it usually takes a few minutes. You can go home right afterward, and no anesthesia is needed.
What does a Pap test usually feel like?
Most people feel brief pressure or discomfort rather than severe pain, but everyone’s experience is different. Taking the sample is usually quick. If you are worried or uncomfortable with the exam, tell your doctor before it starts.
Spotting after a Pap test
A small amount of light bleeding (spotting) for a short time after a Pap test is common and usually nothing to worry about.
Before your Pap test
It is best not to have the test during a heavy period. It is also recommended to avoid douching (washing inside the vagina), vaginal suppositories, vaginal creams and sex for a short time before the test, because these can lower the quality of the sample.
Who should be screened?
If you are single and have never had sex, or have never had penetrative sex
Whether you need screening depends on your age and whether you have had sexual contact. It does not depend on marital status. HPV can spread through genital skin-to-skin contact, even without penetrative sex. If you have never had any kind of sexual contact, the chance of infection is very low, but not zero. Talk to your doctor about whether you need screening.
Do I still need screening after the HPV vaccine?
Yes. The HPV vaccine does not cover all high-risk types, so screening on schedule is still recommended for people who have been vaccinated.
Screening after menopause
Menopause on its own is not a reason to stop screening. The decision to stop depends on your age and your past test results.
Screening during pregnancy
A Pap test can be done during pregnancy if needed, and it does not cause a miscarriage. Even so, many programs postpone routine screening until after the birth (about 3 months after the end of the pregnancy). If your screening is due while you are pregnant, plan the timing with your doctor.
After removal of the uterus (hysterectomy)
Whether screening continues depends on whether the cervix was left in place and why the surgery was done:
- If both the uterus and the cervix were removed, and the surgery was not for cancer or high-grade precancerous changes, screening usually does not need to continue.
- If the cervix was left in place, screening continues on the usual schedule.
- If the surgery was for cancer or high-grade precancerous changes, follow-up continues on a schedule set by your doctor.
Is one screening test enough?
No. Screening is repeated at regular intervals over the years. A normal result today does not cancel your next screening; it only sets when it is due.
When does screening stop?
Screening can stop when both of these conditions are met:
You have reached about age 65, and you have had enough past screening tests, all with normal results. If you have not been screened for years, reaching this age is not, on its own, a reason to stop.
However, after high-grade changes such as CIN 2 or CIN 3, follow-up continues for at least 25 years, even beyond age 65.
After your screening results: what happens next?
If your result is normal
This means nothing worrying was found this time. All you need to do is have your next screening at the recommended interval. A normal result today does not cancel future screenings.
If your result is abnormal
An abnormal result does not mean cancer. Most abnormal results show mild changes, and many of these go away on their own. The next step depends on the type of result and your age, and is usually a repeat test or a colposcopy.
If HPV was found but your Pap test was normal
This means HPV was found in the sample (a positive result), but the cells have not shown any changes yet. This combination is common and does not, on its own, mean you have a disease. This result does need follow-up; your doctor will decide what kind and when.
HPV vaccination and screening complement each other
HPV vaccine
Helps protect against infection with some types of HPV
Screening
Finds cell changes in the cervix early
Neither one replaces the other. They work together.
The vaccine does not cover all high-risk HPV types, so screening is still needed after vaccination.
Screening, on the other hand, does not prevent infection with the virus, but it helps find cell changes in the cervix early.
WHO global prevention targets for 2030
- 90% of girls fully vaccinated by age 15
- 70% of women screened with a high-quality test by age 35, and again by age 45
- 90% of women found to have precancerous changes or cancer receive treatment
Frequently asked questions about cervical cancer screening
Is an HPV test better than a Pap smear?
Neither is better in every case; the choice depends on age. From 30 to 65, the HPV test is the preferred method because it finds the virus before any cell changes appear. From 21 to 29, the Pap test is preferred because HPV infection is common at this age and often short-lived.
Do I need screening if I've never had penetrative sex or I'm not married?
The decision is based on your age and whether you have had sexual contact, not on whether you are married. If you have never had any sexual contact, the chance of infection is very low, but not zero. The best thing to do is to talk it over with your doctor.
My Pap smear result was abnormal. Does that mean I have cancer?
No. Most abnormal results show mild changes. What your result means and what happens next are explained on our cervical cancer diagnosis page.
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