Cervical cancer usually develops from precancerous cell changes that form over years and cause no symptoms. The aim of cervical cancer screening is to detect these changes before they turn into cancer. Two tests are used in screening: the Pap smear test, which examines cells, and the HPV test, which looks for the types of HPV that can cause cervical cancer. Both tests can be done at the same examination, using a sample taken from the cervix.
The difference between a Pap smear and an HPV test
- Pap smear (cytology): shows whether there are changes in the cells of the cervix. The sample is sent to the laboratory either spread on a glass slide (conventional method) or in a special liquid (liquid-based cytology).
- HPV test: shows whether high-risk types of HPV, which can cause precancerous changes and cervical cancer, are present. On its own, it does not show whether there are changes in the cells.
When the HPV test is positive, the Pap smear result from the same sample is used to decide the next steps. HPV and the steps that follow an HPV result are covered on the HPV Testing and Follow-up page.
The screening program in Türkiye
In the Turkish Ministry of Health screening program, cervical cancer screening is offered every five years to women aged 30 to 65 using an HPV test. If the HPV test is positive, colposcopy or a repeat test after one year is planned according to the HPV type and the Pap smear result. Screening is free of charge at family health centers and KETEMs (Cancer Early Diagnosis, Screening and Training Centers). Whether screening is needed outside this age range is assessed according to previous results and health history. International guidelines recommend that, in people with a weakened immune system, such as those living with HIV, screening starts at a younger age and is done more often.
How is the test done?
On the examination table, an instrument called a speculum is placed in the vagina so that the cervix can be seen. A sample of cells is taken from the cervix with a soft brush. Taking the sample takes a few minutes. There may be a feeling of pressure or discomfort during the test; some people may feel pain. The procedure can be stopped at any time on request. Light spotting may occur for a few hours after the test.
Before the test
If possible, choosing a day outside the period is advised. It is advised to avoid intercourse, vaginal medicines or creams and douching for two days before the test.
Results
Pap smear results are usually reported using a common terminology called the Bethesda system. Terms often seen in the report include:
- Normal (NILM): no precancerous change has been found.
- ASC-US: some cells do not look completely normal, and the significance of the change is unclear. This is the most common abnormal result.
- LSIL: a low-grade cell change, usually caused by HPV.
- ASC-H and HSIL: indicate the possibility or presence of a high-grade change; further assessment is needed.
- AGC: indicates changes in the glandular cells of the cervix or the inside of the uterus; further assessment is needed.
If the sample is not adequate for examination, the result is reported as unsatisfactory and the test is repeated. An abnormal result does not mean cancer; most people with abnormal results do not have cancer. The next steps depend on the type of result, the HPV result, age and previous test results; colposcopy is performed when needed.
Limitations and possible risks
No screening test detects every change. A Pap smear may miss some changes or show an insignificant change as abnormal; for this reason, screening is repeated at regular intervals. Abnormal results can lead to further tests and anxiety. Possible side effects of the test itself are light spotting and brief discomfort.
Screening is intended for people without complaints. Complaints such as bleeding between periods or after intercourse, bleeding after menopause and unusual discharge are assessed by examination without waiting for the next screening.