Should You Take A Pap Smear, HPV Test, Or Both?

Everything You Need to Know About Cervical Cancer Screening

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Cervical Cancer is a disease that strikes fear in many women.

According to the National Cancer Institute, in 2015 an estimated 257,524 women were living with cervical cancer in the United States.

Although this figure sounds alarming, the good news is – screening works.

In areas where screening for cervical cancer is readily available, the number of new diagnoses each year is much lower than areas where screening is limited.

Because of this, it is crucial that all women have access to the best information about cervical cancer screening.

Unfortunately, as there are three options – the Pap smear, the HPV test, and co-testing – the guidelines about which test is most effective can be confusing.

The aim of this article is to provide you with all the information you need about cervical cancer screening. We’ll outline the pros and cons of the three processes available so you can use this information to decide which is the best one for you.

What Causes Cervical Cancer?

The cervix is the narrow passage at the bottom of the uterus, just above the birth canal.

Sometimes cells in the cervix go through abnormal changes (dysplasia) and if these are undetected, cancer cells can develop and spread deeper into the cervix and nearby organs.

You are more likely to get cervical cancer if you have HPV – the Human Papillomavirus Infection. HPV is normally contracted through sexual contact and is more common in people who have sex earlier in life and/or have many partners.

Other risk factors for cervical cancer include smoking, taking contraceptive pills for more than 5 years, multiple births, and a pre-existing weakened immune system.

Does Screening Work?

Although cervical cancer is a frightening prospect, the good news is – screening works. Scientists know this for two reasons.

Firstly, the decrease in the number of new cases diagnosed has coincided with screening being rolled out across the US.

Between 1975 and 2010 there was a 50% decrease in new diagnoses. Even more remarkably, in women aged 50+, there was a decrease of 65% for the same period. Effective screening was a major contributing factor in this improvement.

Plus, the areas where the diagnosis figures remain high today are the same areas where access to screening is limited.

Screening is so effective in the war against cervical cancer because the disease develops slowly. If abnormal cells are detected early they can be removed before they become malignant.

Cervical Cancer Screening

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Currently, there are three options available for cervical cancer screening – the Pap smear, the HPV test, and co-testing.

The debate about which test is the most accurate can make the screening process seem confusing, particularly because it leads to frequent changes in the guidelines.

The US Preventive Services Task Force recommends women aged 21-29 have a Pap smear every 3 years. Women aged 29-65 are recommended to have either a Pap smear every 3 years, an HPV test every 5 years or co-testing – both tests – every 5 years.

Read on to find out the pros and cons of these tests, and why co-testing could be the most effective option for you.

Pap Test

The Pap test (named after its inventor, Georgios Papanicolaou) is the most common screening test used for cervical cancer.

During the test, cells are collected from the wall of the cervix using cotton, a brush or small stick. They are then examined under a microscope to see if they are abnormal.

HPV Test

An HPV test examines the DNA or RNA of the cells collected from the cervix for signs of the strains of the HPV infection that are most likely to cause cervical cancer. So, while the Pap smear searches for abnormal cells, the HPV test looks for a virus.

Sometimes the cells removed during a Pap smear are also used to carry out an HPV test. In other cases, an HPV test is done instead of a Pap smear or because the Pap smear showed up abnormal cells.


For women aged 30+, co-testing – a procedure that uses both a Pap smear and an HPV test – has been proven to be the most effective way of screening for cervical cancer.

According to Forbes magazine, co-testing has been identified as the most effective screening option by 23 organizations including American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society, the American Society for Colposcopy and Cervical Pathology (ASCCP) and American Society for Clinical Pathology (ASCP).

This is because both tests have advantages. HPV develops slowly into cancer – in most cases it takes decades. This means if a high-risk HPV infection can be identified early, preventative treatment can be given.

However, no screening test is fail-safe, and HPV is no exception. Pap smears have proven to be a highly effective way of identifying abnormal cells before they develop into cancer. Recent developments in the screening process where the cells are placed in liquid before they are examined under the microscope may even result in better diagnosis rates.

Given that each screening process has specific advantages, why not take advantage of both?

What are the Risk Factors for Cervical Screening?

At Mamadoctors we believe that cervical cancer screening is vitally important for all women, but we also believe in giving you all the information so you can make up your own mind.

It’s important that you know that there are risk factors associated with cervical cancer screening.

False-Negative and False-Positive Results

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As I mentioned earlier, no screening test is infallible. In some cases, a screening test might have a negative result even when cancerous cells are present and this might lead to the patient not getting the treatment they require even if they have other symptoms.

Similarly, a screening test could have a positive result when cancerous cells aren’t present, which might not only cause anxiety but also lead to unnecessary tests and procedures. It is not yet known whether this could affect future fertility or pregnancy.

The best way to determine if screening is necessary for you is to talk to your doctor. In most cases it is likely that your doctor will advise that the benefits of screening outweigh the risk-factors unless you fall into one of the following groups:

  • Women under the age of 21 – screening can pick up changes in cervical cells that have nothing to do with cervical cancer
  • Women who have had a hysterectomy for conditions other than cancer
  • Women 65+ who have had a Pap smear with a negative result – they are unlikely to go on to develop cervical cancer

Cervical Cancer Screening: Frequently Asked Questions

How often do you get Pap smears done?

For women aged 21-65, the US Preventive Services Task Force currently recommends Pap smears every 3 years. Women 29-65 are offered the alternative of an HPV test or co-testing every 5 years.

When should you do a Pap smear test?

Although you can have a Pap smear at any time, the best time is in the middle of your menstrual cycle – from a few days after your period finishes until a week before the next one starts.

How long does it take to get your Pap smear results?

Depending on where you live, the results could be available in a few days or up to three weeks.

What happens after an abnormal Pap smear result?

First of all, it is important not to panic. An abnormal Pap smear result does not necessarily mean you have cervical cancer. It means abnormal cells have been detected.

Your doctor will decide which further tests are required depending on the type of abnormal cells that have been detected. It’s likely that your doctor will do a colposcopy and a biopsy.

A colposcopy is a bit like a smear test, but your doctor will use an instrument called a colposcope to look at your cervix and spot any unusual looking cells. If abnormal cells are detected, a biopsy – a sample of cells – is taken to be examined under a microscope.

Can you do a Pap smear/HPV test at home?

At-home cervical cancer testing kits are available and it is certainly better to test yourself than not be tested at all. There is a debate, however, about whether these tests are as effective as a test carried out by a health professional and in many cases, home-testing kits are not covered by health insurance.

Should you do a Pap smear when pregnant?

Most of the time Pap smears are safe in the first 24 weeks of pregnancy but if you have any concerns speak to your doctor. Following pregnancy, you will probably be advised to wait 12 weeks to get a more accurate result.

Does a routine Pap smear test for HPV?

A Pap smear only tests for abnormal cells that can lead to cervical cancer. It’s possible for your doctor to carry out tests for HPV or other STDs at the same time, but these are not covered by a routine Pap smear test.

When does a woman stop getting Pap smears/HPV tests?

The US Preventive Services Task Force recommends women over the age of 65 who have previously tested negative and are not in a high-risk category no longer need cervical cancer screening.

Which is the most effective test for cervical cancer – Pap smear, HPV test or both?

Huge strides have been made to reduce the number of women who suffer from cervical cancer.

Although the current recommendation from the US Preventive Services Task Force is for women aged 29 to 65 to choose between a Pap smear every 3 years, an HPV test every 5 years, or co-testing every 5 years, current research suggests that co-testing is the most effective screening method for women in this group.

This is endorsed by many agencies including the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society, the American Society for Colposcopy and Cervical Pathology (ASCCP) and American Society for Clinical Pathology (ASCP).

The best news about cervical cancer is that screening works.

When were you last tested?

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Written by Sue Holloway

Medical Information Specialist and writer specializing in health and wellness. She is a mom to three active kids: a teen and two tweens. Originally from the UK, Sue now lives in Singapore with her family. She believes passionately in providing information based on the best evidence to help families make informed decisions about their health. She is particularly interested in natural health strategies and nutrition.