Cervical Screening Explained

What cervical cancer is and why early detection matters.

While cervical cancer ranks as the fourth most common cancer in women worldwide, and is the top cause of cancer related deaths among women in sub-Saharan Africa, it is largely preventable. However, it remains a major public health problem in South Africa and across the low-middle income countries.

Dr Tebogo Hlako, a gynaecologist and obstetrician at Mediclinic Louis Leipoldt, explains, “Cervical cancer is a type of cancer that starts in the cervix, which is the lower part of the womb that opens into the vagina. It usually occurs as a result of persistent human papillomavirus (HPV) cells causing changes in the cervix cells over time. There are many high-risk HPV types, but types 16 and 18 play a major role in the development of cervical cancer.”

Most cervical cancers start from precancerous changes. The key is to find the disease when only abnormal cells are present, before they progress to cancer. Screening (Pap smear/HPV test) can detect these changes early, before they turn into cancer. Early-stage disease may be treated with simpler, less invasive methods. There is also a higher chance of cure if cervical cancer is found at an early stage where treatment is often effective, and with survival rates being much higher.

What is Pap smear/HPV test and how does it work

Dr Hlako explains that cervical cancer screening is done mainly through Pap smears and HPV testing, used separately or in combination.

• Pap smear: A simple procedure that involves softly collecting cells from the cervix. The collected cells are examined under a microscope to check for abnormal changes that could turn into cancer.
• HPV test: A test that looks for the presence of high-risk types of the Human Papillomavirus (HPV), the main cause of cervical cancer. A sample of cervical cells (often collected the same way as a Pap smear) is tested in the lab to see if cancer causing HPV is present.

How often you should have a Pap smear and/or HPV testing

In HIV negative women, screening should begin at age 25

• If your results are normal, you need a Pap smear every 3 years or HPV test every 5 years.
• Screening exit is individualised and guided by your doctor, typically between 50-65 years or after hysterectomy.

In HIV positive women, screening should start at the time of diagnosis

• Pap smears should be done every year or HPV tests every 3 years.
• Screening should continue for life.  

Common myths about a pap smear and HPV testing

Myth: “Pap smears are painful and invasive”

Fact: While you may experience some slight discomfort during the test, it’s generally a painless and quick procedure.

Myth: “You don’t need a Pap smear if you feel healthy”

Fact: Cervical cancer often does not cause noticeable symptoms in early stages. Routine screening is of importance to detect abnormal cell changes before they progress into cancer.

Myth: ‘’You don’t need a Pap test after menopause’’

Fact: Testing is recommended until at least 65, and HIV negative.

Myth: “Once vaccinated for HPV, you don’t need Pap smears”

Fact: The HPV vaccine is highly effective in preventing infection with certain strains of HPV that can lead to cancer. However, it doesn’t protect against all strains.

Myth: “Abnormal test means you have cancer”

Fact: Abnormal results often indicate precancerous changes, not cancer itself. Follow-up tests help clarify the situation.

Myth: “A positive HPV test means you’ve been unfaithful”

Fact: HPV can remain dormant for years and is not a moral judgment but simply reflects viral biology.

Tips for preparing for your Pap smear or HPV testing

• Avoid sexual intercourse, douching, vaginal creams, tampons, and other vaginal products at least 2 days before the test.
• Try to schedule your appointment when you are not menstruating to ensure the most accurate results.
• On the day of the test: Continue with your usual eating and drinking, and ensure your bladder is emptied. Wear comfortable clothing. Shaving and waxing is completely optional.
• You are allowed to bring a trusted friend or family member for support and reassurance.
• Remember to stay relaxed, as the procedure is quick and painless.

HPV vaccinations are a powerful prevention tool

The HPV vaccine is very important because it is highly effective and protects against the virus that causes most cervical cancers. The World Health Organization (WHO) recommends the vaccine for girls and boys aged 9-14years (one or two doses). If not given earlier, the vaccine can still be given up to age 26 (one or two doses depending on age at start). For adults aged 27 to 45, a three-dose schedule is recommended.

“It is important not to believe the myths around screening. The tests are quick, safe, and effective. Your health matters — talk to your doctor or clinic about screening and vaccination,” Dr Hlako concludes.