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Cervical cancer used to be one of the deadliest cancers for American women. But widespread use of the Pap test for screening improved the picture dramatically. More recently, providers have added testing for human papillomavirus (HPV), a very common virus that sometimes causes cervical cancer.
Together, Fred Hutch Cancer Center and UW Medicine offer screenings to reduce the risk of cervical cancer or to find it at its earliest stage.
Schedule Your Screening
Talk to your primary care provider about cervical cancer screening. UW Medicine Primary Care can help you get started with screening. Learn about Fred Hutch's relationship with UW Medicine.
HPV Test for Cervical Cancer Screening
Infection with certain types of HPV increases the risk for cervical cancer, vulvar cancer and other cancers. An HPV test is a common part of a pelvic exam (when your primary care provider or gynecologist looks at and feels your reproductive organs to check for any problems).
During an HPV test by a health care provider, you will lie on your back on an exam table with your feet in stirrups. Your provider will use a speculum to hold open your vagina. They will use a small brush, swab or spatula to take a tiny sample of cells from your cervix. These cells will be tested for the virus.
There are also kits you can use to collect a sample yourself using a soft swab. If you prefer this option, ask your provider to order a kit for you. It’s important to use a kit approved by the U.S. Food and Drug Administration (FDA). You can collect the sample privately, either at home or at your provider’s office.
The American Cancer Society recommends that women ages 25 to 65 get a primary HPV test (an HPV test done on its own for screening) every five years if done by a health care provider or every three years if you use a self-collection kit. Another option is to have a co-test (HPV test and Pap test at the same time) every five years. Some HPV tests are approved by the FDA as primary tests. Some are approved only as co-tests.
Testing positive for HPV (meaning you have the virus) does not mean you have cancer or will get cancer. Talk with your provider about your results, your risk for cervical cancer and the best next steps (like having a Pap test, if you didn’t already).
Learn more about HPV and how to prevent it.
Pap Test for Cervical Cancer Screening
A Pap test is a way to check for abnormal cells on the cervix before they become cancer or to find cervical cancer early, when it’s highly curable. About 90% of women whose cervical cancer was found by a Pap test will survive.
It’s done the same way as an HPV test, often at the same time. During a pelvic exam, your provider takes a small sample of cells for testing. The cells are checked for precancer (changes that might turn into cancer if not treated).
The American Cancer Society recommends that women get a Pap test every three years. An abnormal result from a Pap test does not always mean you have cancer or even precancer. Talk with your provider about what your results mean and if you need to have further testing or take any other steps.
History and Exam for Cervical Cancer Screening
If you have signs or symptoms that could be from cervical cancer (or another problem with your reproductive organs), your provider will ask you about your symptoms, your health history and your family history. They may ask about factors that might put you at risk for cancer or other conditions that might cause the same symptoms.
Then, they’ll examine you to check for clues about what’s been bothering you. They will probably do a general physical exam and then a pelvic exam.
Based on your conversation and exam, your provider may order tests to get more information.
Cervical Cancer Biopsy
The only way to tell whether you have cervical cancer is to examine samples of tissue. To do this, physicians have to remove a small sample of tissue from your cervix and send them to a lab where they can be examined under a microscope. This is called a cervical cancer biopsy. You may need a biopsy if your Pap results were abnormal, you have HPV or you have certain signs or symptoms.
Colposcopy
As part of your cervical cancer screening, your provider may use a tool with a magnifying lens called a colposcope to examine your cervix. This procedure is called colposcopy. To help abnormal cells stand out, the provider may apply a small amount of liquid (either diluted acetic acid or dye) to the part of your cervix they’re concerned about.
If the provider sees abnormal cells that need to be tested, they may give you numbing medicine in that area. Then they’ll take out a tiny section of the surface of the cervix. This can be done in an office visit using a biopsy forceps (tool that snips a small piece of tissue) or a punch biopsy (circular tool that takes a small, round piece of tissue). Your provider might also insert a curette (thin spoon-like tool) into your cervix to perform an endocervical curettage (scrape of some cells from the area).
Cone Biopsy
Sometimes, providers need to perform cone biopsy or conization (remove a larger, cone-shaped piece of tissue). They might do this with a thin wire loop in an office visit. This is a loop electrosurgical excision procedure, or LEEP, also called large loop excision of the transformation zone, or LLETZ. Or they might use a scalpel or laser in an operating room.
If you have precancer or a very early cancer, the provider might be able to remove all of it with LEEP/LLETZ or a surgical or laser cone biopsy.
Imaging Studies for Cervical Cancer Screening
In certain situations, your provider may also want you to have imaging studies as part of the diagnosis process. These could give your care team more information, such as whether your cancer has spread. Imaging might include an X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or positron emission tomography (PET) scan. Your care team might also use a thin, tube-shaped tool with a camera on the end to look inside your bladder (cystoscopy) or colon (sigmoidoscopy).
Why Choose Fred Hutch for Cervical Cancer Care
When you choose Fred Hutch for care, our experts confirm your cervical cancer diagnosis. Before your first visit, your care team will review your pathology slides (tissue samples from biopsies) and any scans or tests you have already had. We have a dedicated pathologist who specializes in diagnosing gynecologic cancers. If needed, we will do further tests on your tissue sample.
During your first visit, you’ll see your gynecologic oncologist, who will ask about your medical history and symptoms and do an exam. Then, you’ll meet with the oncologist and other members of your care team to talk about what we found and what we recommend for you.
After your initial consultation, we’ll work with you so you can receive some of your treatment in your community, if you prefer.
“Once we evaluate the patient and establish their treatment strategy, we frequently partner with community oncologists to provide care closer to home,” said gynecologic oncologist Barbara Goff, MD. “This is especially helpful for patients who live outside the Seattle area.”
For a cervical cancer biopsy in the provider’s office, you will lie on your back on an exam table with your feet in stirrups, like for a pelvic exam. Your provider will use a speculum to hold open your vagina, like for a Pap test. Before the provider removes cells, they may give you numbing medicine so you won’t feel any pain. This will be an injection (shot) near cells they plan to remove (local anesthetic).
For a cone biopsy in an operating room, you will get general anesthesia (medicine that puts you to sleep) or regional anesthesia (medicine to numb you below the waist). The provider will use a speculum to hold open your vagina. Then they will remove a cone-shaped wedge of tissue from your cervix. They might put gauze in your vagina to stop any bleeding, and you might have a catheter to drain urine from your bladder until the gauze can come out.
If you have a cervical cancer biopsy in a provider’s office, you may have some cramping, like menstrual cramps, during the procedure. You might also have light bleeding or changes in the discharge from your vagina. If you have a cone biopsy, you may have some pain after the procedure, when the anesthesia wears off. Like with many procedures, there is a risk of bleeding or infection.
Your care team will do everything they can to reduce the risks, and they’ll let you know what to watch for. They will give you guidelines about the best ways to take care of yourself as you heal. They may also let you know some steps to take after the procedure, like not using tampons or having vaginal sex for a certain amount of time.
The time it takes for results may depend on which tests the pathologist needs to run. Tests may take from a few days to a week or more. After tests are done, the pathologist will write a report saying what they found. When you go in for your biopsy, ask your care team how long it will take to get results.