What is cervical cancer?

Cervical cancer is cancer of the cervix, which is located at the opening of the uterus. Cervical cancer is almost entirely preventable with regular screening, appropriate and timely follow-up of abnormal results and human papillomavirus (HPV) immunization.

What is cervical screening?

Screening for cervical cancer is done through a Pap test – a cervical swab that collects cells from the cervix to look for abnormal cell changes. It does not test for other cancers in the reproductive organs or for chlamydia, gonorrhea, or HIV. The procedure only takes a few minutes.

Who should be screened for cervical cancer?

The Ontario Cervical Screening Program (OCSP) recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21. If you have questions about these guidelines, visit your healthcare provider for more information. In general the guidelines for screening include the following:

  • If you have ever had any sexual skin-to-skin contact, you need to have regular Pap tests starting at age 21. This includes intercourse, intimate touching or oral sexual contact.
  • Pap tests should be a part of your regular health check-up until you are 69 years old. The risk of getting cancer of the cervix does not decrease with age.
  • Pap tests can stop at the age of 69 if you have had three or more normal tests in the prior 10 years.
  • If you have had a hysterectomy, talk to your healthcare provider to see if you still need a Pap test.

Why is cervical screening (Pap testing) needed?

Cervical cancer is preventable. Screening is the only way to detect the early changes that might lead to cervical cancer. Most cervical cancers are diagnosed in women who have never been screened or have not been screened regularly.

Pap testing is an essential defense against cervical cancer because it can detect early cell changes on the cervix caused by persistent human papillomavirus (HPV) infection. These changes seldom cause any symptoms, but can progress to cancer if not found, and, if necessary, treated.

How do I know if I need a Pap test?

You should get a regular Pap test if you are between the ages of 21 and 69 and have ever been sexually active. This includes women who:

  • Have had only 1 sexual partner.
  • Have been with their partner for awhile.
  • Have had the HPV vaccine.
  • Have been through menopause.
  • Are no longer sexually active.
  • Are in a same-sex relationship.

What happens during a Pap test?

A Pap test is done in a healthcare provider’s office. The test looks for abnormal cell changes on the cervix. You will be asked to lie on your back on the examination chair. An instrument, called a speculum, is gently inserted in your vagina so your cervix can be more clearly seen. Cells are taken from the cervix and are sent to a laboratory to be examined under a microscope. Some women may find it uncomfortable or embarrassing but it takes only a few minutes and could save your life.

How often should I be screened?

Cervical cancer screening is recommended every three years for women ages 21 to 69 who are or ever have been sexually active. Ontario cervical screening guidelines recommend that women over the age of 69 can stop having Pap tests when they have had three or more normal tests in the prior 10 years.

Is it true that I don’t need Pap tests if I am older than a certain age?

Screening may be stopped after age 69 if you have had three normal Pap test results in the past 10 years and have no history of biopsy that confirmed significant abnormalities. If you are unsure of when you should stop getting regular Pap tests, talk to your healthcare provider.

What is an unsatisfactory Pap test result?

An unsatisfactory result usually means that the sample collected from your cervix did not have enough cells or the cells could not be seen well enough under the microscope. You will need to do your Pap test again. Thirty per cent of women will have an abnormal Pap test result in their lifetime. Cell changes found through Pap tests are very rarely cancer but do require follow-up testing.

Do we know what causes cervical cancer?

Most cervical cancers are caused by a common virus called HPV (human papillomavirus) which is easily spread through sexual contact, including intimate touching, oral, vaginal and anal sex. Three out of four sexually active people will get HPV at some point in their lives – often without knowing it.

Can I develop cervical cancer if I have only had one sexual partner?

Yes. No one can pinpoint why one woman develops cervical cancer and another does not.

Can cervical cancer be prevented?

Cervical cancer is preventable. Each year, about 630 women are diagnosed with cancer of the cervix and about 150 women die from this disease in Ontario. Screening is the only way to detect the early changes that might lead to cervical cancer. Most cervical cancers are diagnosed in women who have never been screened or have not been screened regularly.

To learn more about how you can reduce your risk of developing cervical cancer, click here.

Do Pap tests screen for all gynecological cancers?

The only cancer Pap tests screen for is cervical cancer. The Pap test does not screen for other gynecologic cancers such as ovarian and fallopian cancer. Contact your healthcare provider if you have questions about gynecological cancers not screened by the Pap test.

Do Pap tests screen for sexually transmitted infections (STIs)?

A Pap test does not test for STIs. If you would like to have STI testing done, contact your healthcare provider or local Sexual Health Clinic.

If I have HPV, will I develop cervical cancer?

Not necessarily. There are more than 100 types of HPV – some types are high risk for cervical cancer, while others are high risk for genital warts. HPV types 16 and 18 cause 70% of cancers of the cervix. Usually, the body’s immune system clears the virus by itself within 2 years. But for some women HPV does not clear from the body and over time, it can cause abnormal cell changes in the cervix that you cannot see or feel. These abnormal cells can develop into cervical cancer if they are not found and treated early enough.

Is it true that if I have received the HPV vaccine I don’t need Pap tests?

No. Regular Pap tests are still necessary for women who have had the HPV vaccine. The vaccine is intended to protect against certain HPV strains. The vaccine protects against 2 high-risk HPV strains known to cause cervical cancer, but there are other strains associated with cervical cancer and the vaccine will not protect you against these strains.

What about screening for those with special circumstances?

These guidelines do not apply to:

  • Women who have been previously treated for dysplasia. Screening intervals should be individualized and should likely be annual.
  • Immunocompromised women should receive a Pap test every year.
  • Women who have undergone subtotal hysterectomy and retained their cervix should continue screening according to the guidelines.
  • Pregnant women should be screened according to the guidelines; however, care should be taken not to over-screen. Only conduct Pap tests during pre-natal and post-natal visits if the woman is otherwise due for screening.
  • Women who have sex with women should follow the same cervical screening regimen as women who have sex with men.

What is my risk of developing cervical cancer?

  • To learn your personal risk of developing cervical cancer you can use an online tool called My CancerIQ.

I am Transfeminine, do I need a pap test?

  • If you’re a trans woman who has not had any type of bottom surgery, you don’t need to be screened for cervical cancer.
  • If you’ve had a vaginoplasty that included the creation of a cervix, you should get regular Pap tests if you are age 21 and over, and sexually active. This type of bottom surgery is very rare.
  • If you had a vaginoplasty that didn’t include the creation of the cervix, you may have a very small risk of developing cancer in the tissues of your neo-vagina. Your risk may be higher if you have a history of HPV infections or a suppressed immune system. You should talk to your healthcare provider to understand your specific cancer screening needs as part of your overall pelvic health following surgery.
  • In some cases, a test similar to a Pap test called a “vault smear” or “cuff smear” can be used to look for abnormal or precancerous changes to your neo-vagina. These tests are not as effective as Pap tests in detecting cancer. You and your healthcare provider should decide together whether you should get these tests, based on your individual risk.
  • For more information about screening for trans people please visit the Canadian Cancer Society’s Get Screened webpage

I am Transmasculine, do I need a pap test?

  • If you’re a trans guy age 21 or older who has ever had sex — with anyone — then you need to get screened for cervical cancer if you have a cervix. Screening means finding cancer before there are any noticeable symptoms by getting a Pap test every three years. Regular screening is the best way of preventing cervical cancer or finding it early, when treatment is most effective. Anyone with a cervix can get cervical cancer. The good news is that a simple, three-minute Pap test can save your life.
  • For more information about screening for trans people please visit the Canadian Cancer Society’s Get Screened webpage