A simple test that can help prevent cervical cancer
“A few
minutes of screening can protect your health for years.”
Cervical
cancer is one of the cancers that can often be prevented through regular
screening and appropriate follow-up.
One of the
familiar screening tests is the Pap smear, also called the Papanicolaou
test. It examines cells collected from the cervix to look for abnormal
changes that may represent precancerous lesions or, less commonly, cancer.
The
important message is simple:
Pap smear
is not just a test for cancer — it can detect changes before cancer develops.
What
exactly is a Pap smear?
The cervix
is the lower part of the uterus that opens into the vagina.
During a Pap
smear, a healthcare professional gently collects cells from the surface of the
cervix using a small brush or spatula. The cells are then examined under a
microscope by a cytopathologist.
The test may
be performed as:
- Conventional Pap smear
- Liquid-based cytology (LBC)
Both methods
examine cervical cells for abnormalities.
Why do
abnormal cervical cells develop?
The most
important cause of cervical cancer is persistent infection with high-risk
types of human papillomavirus (HPV).
HPV
infection is extremely common and many infections clear naturally. The concern
is persistent infection with high-risk HPV types, which can cause progressive
changes in cervical cells over time.
The sequence
may be:
HPV
infection → persistent infection → cervical cell changes → precancer → cervical
cancer
This process
often takes years, which creates an important opportunity for screening and
treatment.
Does a
Pap smear detect HPV?
Not
directly.
A Pap smear
looks primarily at cervical cells and identifies cellular abnormalities.
An HPV
test looks for high-risk HPV infection.
Depending on
the screening programme, HPV testing, cytology, or a combination/triage
strategy may be used.
Importantly,
current WHO guidance increasingly prioritizes HPV DNA testing as the
preferred primary screening method for cervical cancer prevention. Cytology
remains an important test, particularly in settings and algorithms where it is
used for screening or triage.
What can
a Pap smear report show?
A Pap smear
can be:
🟢 NILM – Negative for intraepithelial
lesion or malignancy
This means
no significant epithelial abnormality is identified.
Other
findings such as inflammation, infection-related changes or benign cellular
changes may sometimes be mentioned separately.
🟡 ASC-US
Atypical
Squamous Cells of Undetermined Significance
The cervical
squamous cells look slightly abnormal, but the changes are not sufficient to
classify them as a definite precancerous lesion.
Further
management may depend on HPV testing, age and previous screening history.
🟠 LSIL
Low-grade
Squamous Intraepithelial Lesion
This usually
represents HPV-associated low-grade cellular changes.
Many
low-grade lesions regress spontaneously, particularly in younger women, but
appropriate follow-up is important.
🔴 HSIL
High-grade
Squamous Intraepithelial Lesion
This
indicates more significant cellular abnormalities and requires appropriate
clinical evaluation and follow-up, often including colposcopy.
Other
abnormalities
Pap reports
can also identify or suggest:
- Atypical glandular cells
- Adenocarcinoma in situ
- Squamous cell carcinoma
- Other less common abnormalities
An
abnormal Pap smear does not automatically mean cancer.
It means
that further evaluation may be necessary.
Does an
abnormal Pap smear mean I have cancer?
No.
This is one
of the most important things women should know.
An abnormal
cytology result may represent anything from minor transient cellular changes to
a high-grade precancerous lesion.
Only
appropriate follow-up — which may include HPV testing, repeat cytology,
colposcopy and/or biopsy depending on the result and clinical circumstances
— can determine what the abnormality represents.
Is a Pap
smear painful?
For most
women, the procedure is brief and causes little or no pain, although
some women may experience pressure or mild discomfort.
A speculum
is gently inserted into the vagina to visualize the cervix, followed by
collection of the cervical cells.
The entire
procedure usually takes only a few minutes.
How
should I prepare for a Pap smear?
Your
healthcare provider may advise you to:
- Avoid vaginal intercourse for
about 24–48 hours before the test.
- Avoid vaginal medications or
creams immediately before the test unless advised otherwise.
- Schedule the test when you are
not having heavy menstrual bleeding, if possible.
- Tell your healthcare provider
about pregnancy, recent procedures or symptoms.
Your doctor
or laboratory may provide specific instructions depending on the type of test
being performed.
Who
should undergo cervical cancer screening?
Screening
recommendations depend on age, previous screening results, HPV status,
vaccination status, medical history and the screening programme available in
your country or region.
WHO's
current approach places increasing emphasis on HPV-based screening. Its 2026
guideline provides risk-based approaches using HPV genotyping and different
triage strategies.
Therefore,
instead of assuming that every woman needs the same test at the same interval,
it is better to discuss the appropriate screening strategy with your healthcare
provider.
Pap smear
vs HPV test
|
Pap
smear |
HPV
test |
|
Examines
cervical cells |
Detects
high-risk HPV infection |
|
Identifies
abnormal cellular changes |
Identifies
an important cause of cervical precancer |
|
Cytology-based
test |
Molecular
test |
|
Can be
used for screening or triage depending on the programme |
Increasingly
recommended as primary screening |
|
Requires
cytological interpretation |
Detects
high-risk HPV DNA or other validated HPV targets |
WHO's recent
guidance supports the transition toward HPV-based cervical screening
programmes while recognizing that implementation depends on
healthcare-system capacity and appropriate follow-up.
What
happens if my screening test is positive?
Don't
panic. Don't ignore it.
A positive
screening result does not necessarily mean cancer.
Depending on
the screening method and result, your doctor may recommend:
Positive
screening result
↓
Risk assessment / triage
↓
Repeat testing, cytology, colposcopy or other evaluation as appropriate
↓
Biopsy when indicated
↓
Treatment of precancerous lesions when required
The purpose
of screening is not simply to find cancer.
The real
goal is to find precancer early — when it can be managed before invasive cancer
develops.
What
about HPV vaccination?
HPV
vaccination is an important part of cervical cancer prevention.
However:
HPV
vaccination does NOT replace screening.
Women who
have received HPV vaccination should still follow the cervical screening
recommendations applicable to them. HPV vaccination and screening are
complementary prevention strategies.
What
symptoms should not be ignored?
Cervical
precancer may cause no symptoms, which is why screening is important.
Symptoms
that deserve medical evaluation include:
- Bleeding after sexual
intercourse
- Bleeding between periods
- Unusual or persistent vaginal
bleeding
- Unusual vaginal discharge
- Pelvic pain
- Pain during intercourse
These
symptoms do not automatically indicate cervical cancer, but they should not be
ignored.
Screening
is for people who may have no symptoms; symptoms require clinical evaluation.
5 things
every woman should remember
1. HPV
infection is common.
Most HPV
infections do not become cancer.
2.
Persistent high-risk HPV infection is the major cause of cervical cancer.
3.
Cervical precancer can often be detected before invasive cancer develops.
4. An
abnormal Pap smear does not automatically mean cancer.
5.
Screening only helps when abnormal results are followed up appropriately.
The
bottom line
Don't
wait for symptoms to start screening.
Cervical
cancer prevention is a step-by-step process:
HPV
vaccination
+
Appropriate
cervical screening
+
Timely
follow-up of abnormal results
+
Treatment
of precancer when necessary
=
Better
protection against cervical cancer
The Pap
smear has played an important role in cervical cancer prevention for decades.
Today, HPV-based screening is becoming increasingly central to cervical cancer
prevention programmes, while cytology remains an important component of many
screening and triage pathways.
Your
health deserves a few minutes of attention today — not years of regret later.
Dr.
Sunita Samleti
Senior Consultant Pathologist
Pathology & Oncopathology Consultation Service
Patient education | Cancer prevention | Women’s health
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