There are 2 main strategies in the prevention of cervical cancer:

• Human Papillomavirus (HPV) vaccination
• Cervical cancer screening via Pap test or HPV test

In my practice, I have encountered much confusion from my parents regarding the above. This article aims to address the common questions regarding cervical cancer screening. Do check out Part 1 which aims to address the questions regarding HPV and HPV vaccination.

Questions regarding cervical cancer screening:

• What is cervical cancer screening?
  • Cervical cancer screening involves checking the cells in the cervix via a Pap test or a HPV test.
• What happens during cervical cancer screening?
  • The doctor will insert a device called a speculum into your vagina. The speculum helps to push apart the walls of the vagina so that the doctor can see the cervix.
  • The doctor will then use a small spatula or brush to lightly scrape the cells from the surface of the cervix to send for either the Pap test or HPV test.
• What are the differences between Pap test and HPV test?
  • It is important to find out from your doctor which screening test you have gone for previously if any, as that will impact the screening interval, as detailed in the table below.

Differences	Pap Test	HPV test
What is the lab testing?	The lab will study the cells under a microscope to check for any abnormalities in the cells of the cervix, which can include cancer cells or pre-cancer cells.	The lab will check for the presence of the HPV virus in the cells of the cervix.
Recommended age to start screening	21 to 29 or 25 to 29, depending on where you are from. In Singapore, the recommended age to do the Pap test is 25-29 years old.	25 and above or 30 and above, depending on where you are from. In Singapore, the recommended age to do the HPV DNA test is 30 years and above.
Recommended interval if you have a normal result	Every 3 years	Every 5 years

• What should I do to prepare for a Pap or HPV test?
  • Contrary to old recommendations that a patient should avoid sex or put anything in their vagina (e.g. vagina douching, tampons, vagina gels, lubricants or medications) for 2 days before a Pap test, the studies conducted have shown that these do not affect the results of the Pap or HPV test.
  • Menstruation will not affect the HPV test results. Menstrual bleeding may affect the Pap test result if the doctor is using the conventional Pap smears rather than the liquid-based Pap test, as the liquid-based technique can help to filter out the blood.
  • Some doctors may have specific preferences regarding the above as well as the test to perform. Therefore, it is important to check with your doctor beforehand so as to avoid making a wasted trip down to the clinic.

Note: It is extremely important to follow up with your doctor the result of the cervical cancer screening as the interval of the cervical cancer screening will depend on the results.

Useful links:

• Healthhub: https://www.healthhub.sg/a-z/costs-and-financing/cervical-cancer-screening-subsidies-in-singapore#:~:text=Women%20who%20are%2025%20years,test%20once%20every%20five%20years.

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• Colorectal Cancer Screening
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References:

• Harper, D. M., Longacre, M. R., Noll, W. W., Belloni, D. R., & Cole, B. F. (2003). Factors affecting the detection rate of human papillomavirus. Annals of Family Medicine, 1(4), 221. [PubMed: 15055412]
• Chen, F. C., Shaw, S. W., Cheng, P. J., Hsueh, S., & Lin, C. T. (2008). Diagnosis of human papillomavirus infection by abnormal cervical cytology is highly reproducible after vaginal douching. Taiwanese Journal of Obstetrics & Gynecology, 47(4), 412. [PubMed: 19126507]
• Griffith, W. F., Stuart, G. S., Gluck, K. L., & Heartwell, S. F. (2005). Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception, 72(1), 60. [PubMed: 15964294]
• Amies, A. M., Miller, L., Lee, S. K., & Koutsky, L. (2002). The effect of vaginal speculum lubrication on the rate of unsatisfactory cervical cytology diagnosis. Obstetrics & Gynecology, 100(5 Pt 1), 889. [PubMed: 12423848]
• Hathaway, J. K., Pathak, P. K., & Maney, R. (2006). Is liquid-based pap testing affected by water-based lubricant? Obstetrics & Gynecology, 107(1), 66. [PubMed: 16394041]
• Harer, W. B., Valenzuela, G. Jr, & Lebo, D. (2002). Lubrication of the vaginal introitus and speculum does not affect Papanicolaou smears. Obstetrics & Gynecology, 100(5 Pt 1), 887. [PubMed: 12423847]
• Tavernier, L. A., Connor, P. D., & Gates, D. (2003). Water vs gel lubricant for cervical cytology specimens. Journal of Family Practice, 52(9), 701. [PubMed: 12967542]
• Vooijs, G. P., van der Graaf, Y., & Elias, A. G. (1987). Cellular composition of cervical smears in relation to the day of the menstrual cycle and the method of contraception. Acta Cytologica, 31(4), 417. [PubMed: 3604536]
• Bernstein, S. J., Sanchez-Ramos, L., & Ndubisi, B. (2001). Liquid-based cervical cytologic smear study and conventional Papanicolaou smears: a metaanalysis of prospective studies comparing cytologic diagnosis and sample adequacy. American Journal of Obstetrics and Gynecology, 185(2), 308. [PubMed: 11518884]
• Sherman, M. E., Carreon, J. D., & Schiffman, M. (2006). Performance of cytology and human papillomavirus testing in relation to the menstrual cycle. British Journal of Cancer, 94(11), 1690. [PubMed: 16670716]