Cervical cancer is tested for with a simple sample of cells collected from your cervix, checked either for the virus that causes cervical cancer (HPV test) or for abnormal cell changes (Pap test). Screening starts at age 25 and is repeated every 3 to 5 years depending on which test you get. The whole process takes just a few minutes in a clinic, and newer options even allow you to collect your own sample at home.
The Two Main Screening Tests
There are two tests used to screen for cervical cancer, and they look for different things. The HPV test checks for high-risk strains of human papillomavirus, the virus responsible for nearly all cervical cancers. The Pap test (also called a Pap smear) looks at your cervical cells under a microscope to see if any have started to change in ways that could eventually become cancer. Both tests use the same type of sample collected from your cervix, and sometimes they’re done together in what’s called co-testing.
The American Cancer Society now considers primary HPV testing the preferred screening option. That means getting tested for HPV alone, without a Pap test. The logic is straightforward: HPV causes cervical cancer, so detecting the virus early catches problems before cell changes even begin. If HPV isn’t present, your risk of developing cervical cancer in the near future is very low.
What Happens During the Test
If your sample is collected in a clinic, you’ll lie on an exam table with your feet in stirrups. Your provider inserts a speculum, a smooth instrument that gently holds the vaginal walls apart so they can see your cervix. Then they use a soft brush and a flat scraping device called a spatula to collect a small sample of cells from the surface of your cervix. The cells go into a small bottle of preserving solution and are sent to a lab.
The collection itself takes about one to two minutes. You may feel pressure or a brief scratchy sensation, but it shouldn’t be painful. Some light spotting afterward is normal. No preparation is needed beforehand, though some providers suggest avoiding intercourse, douching, or vaginal medications for a couple of days before the test since these can affect results.
Self-Collection: Testing Without a Pelvic Exam
Self-collected HPV testing is now FDA-approved as a screening option. For this test, you insert a soft swab into your vagina yourself, either privately in a clinic or at home. No speculum, no pelvic exam. A healthcare provider still needs to order the test and supply the collection device, so you can’t simply buy one over the counter. When done through self-collection, the recommended interval is every 3 years rather than every 5.
Availability is still limited, but it’s expanding. Self-collection is only valid using FDA-approved devices provided by your healthcare provider. If this option appeals to you, ask your doctor or clinic whether they offer it.
When and How Often to Get Screened
Screening should start at age 25 and continue until at least age 65. How often you need to be tested depends on which test you’re getting:
- Primary HPV test (provider-collected): every 5 years
- Self-collected HPV test: every 3 years
- Co-testing (HPV test plus Pap test together): every 5 years
- Pap test alone: every 3 years, if no other option is available
After age 65, you can stop screening if you’ve had consistent normal results: either three consecutive negative Pap tests or two consecutive negative HPV tests within the past 10 years, with the most recent test within the last 5 years. If you’ve had a hysterectomy that included removal of the cervix and you have no history of high-grade precancerous changes, screening is no longer needed. Once you’ve stopped screening after 65, guidelines say it doesn’t need to resume, even if you have a new sexual partner.
What Your Results Mean
Most screening results come back normal, and you simply return for your next test at the recommended interval. When results are abnormal, the terminology can sound alarming, but most abnormal findings are not cancer. They’re flags that something needs a closer look.
A positive HPV result means a high-risk strain of HPV was detected. This doesn’t mean you have cancer. Most HPV infections clear on their own, but your provider will recommend follow-up steps based on which strain was found and whether your Pap results also showed changes.
If your Pap test shows abnormal cells, the results are graded by severity. ASC-US (atypical squamous cells of undetermined significance) is the most common abnormal finding. It means some cells don’t look entirely normal, but the cause isn’t clear, and it may just reflect an HPV infection that will resolve. LSIL (low-grade squamous intraepithelial lesion) indicates mild cell changes, usually from HPV, that your provider will want to monitor with additional testing. HSIL (high-grade squamous intraepithelial lesion) signals more significant cell changes that could become cancer if left untreated, and typically leads to a procedure called a colposcopy.
What Happens If You Need Follow-Up
A colposcopy is the standard next step when screening results suggest cells that need a closer look. During the procedure, your provider uses a magnifying instrument (the colposcope) to examine your cervix in detail. If they see suspicious areas, they take a small tissue sample, a biopsy, from those spots. Targeted biopsies are 8 to 12 times more likely to detect serious precancerous changes than random sampling, which is why the visual exam matters.
A colposcopy feels similar to a Pap test, though the biopsy portion can cause a pinch or cramping. The tissue sample is sent to a lab, and results typically come back within a couple of weeks. Based on what the biopsy shows, your provider may recommend monitoring with repeat testing, or a treatment procedure to remove the abnormal tissue before it has any chance of progressing.
In some cases, particularly for people over 25 who test positive for specific high-risk HPV strains and also have high-grade cell changes on their Pap, a provider may recommend a treatment procedure right away that both removes tissue for diagnosis and treats the abnormality in one step.
Cost and Insurance Coverage
Under the Affordable Care Act, all Marketplace health plans and many other insurance plans must cover cervical cancer screening at no cost to you, with no copayment, coinsurance, or deductible required, as long as you use an in-network provider. This applies to Pap tests for people aged 21 to 65, and HPV testing is covered under preventive care as well.
If you’re uninsured or underinsured, the CDC’s National Breast and Cervical Cancer Early Detection Program provides free or low-cost cervical cancer screening in every state. You can find a local program through your state health department. Community health centers also offer sliding-scale pricing based on income.