Ontario Cervical Screening Guidelines (aka. When you should get your Pap test)

Do you remember your first Pap? I do. Vividly. Truthfully, this is not a test that most women love to get done - but it's an important one! The Pap test screens for cervical cancer as it looks for abnormal cells changes of the cervix. These are not perfect tests, but hopefully routine screening will catch any abnormal cells

Why do I need a Pap test?

The Pap test is used as a means of screening for cervical cancer, one of the most preventable types of cancer.

How is HPV involved?

There over 100 different HPV strains, but not all have the ability to lead to cervical cancer. Some HPV strains may cause genital warts, and these strains will not predispose to cancer.

Cervical cancer can begin as an infection from a high risk strain of HPV at the cervix, and may persist for many years. It can take up to 7 years for an HPV(human papillomavirus) infection to transition into invasive cancer. 

It should be noted that HPV is an infection that has the ability to spontaneously resolve on its own, especially in younger women. This is one of the reasons why screening doesn't begin until the age of 21.  

Even if you have gotten an HPV vaccine, you still need to get a Pap test if you meet all the required criteria. 

When should screening begin?

By 21 years of age, cervical screening (a Pap test) should begin for women if they are or have been sexually active. Sexual activity includes intercourse, as well as oral and digital sexual activity with a male or female partner. Read: women who have sex with women still need to be screened.

If you are pregnant, screening should still be taking place – but may be done in the post-natal period.

For transgender men who still have a cervix, they should be screened according to the guidelines.

For women who have not been sexually active by the time they are 21, they should delay cervical screening until they are sexually active. 

How often should screening take place?

For normal results:

Screening should take place every 3 years. For immunocompromised women, screening should be occurring every year.

Even if your last pap test came back as normal within the 3 year period, but you recently experienced vaginal bleeding (outside your period) or abnormal discharge - get screened again. 

For abnormal results:

If you are less than 30 years old, you are re-tested in 6 months. If your results come back as abnormal a colposcopy will need to be performed. But, if your results come back normal, you will undergo another test at 6 months. If those results are abnormal you will need to have a colposcopy done. But if that final round is normal, you will re-enter the 3 year cycle.

If you are over 30 years old, there will be testing for cancerous HPV strains. If the results are negative, then you will cycle back into that 3 years screening cycle. But if the results are positive for oncogenic HPV strains, a coloposcopy will be done.

When does screening stop?

When a woman is at least 70! It’s true! If she’s had at minimum 3 normal pap exams over the last 10 years, then screening can stop.

What happens if a woman has had a hysterectomy? If she still has a cervix (in the case of a subtotal hysterectomy), then guidelines should still be followed until she’s 70 and has at least 3 normal tests.

Where can you get screened?

You can make an appointment with your medical doctor or your naturopathic doctor (I perform these in clinic). If you can't find a healthcare provider, you can find someone here. Some pelvic health units and community health centres may also perform screenings.

How to get ready for a Pap test

Check your period tracker to make sure that you're not getting a pap while you're on your cycle. It's also advised that you don't have sex, use tampons, apply or insert any medications or creams inside your vagina for at 2 days before the test. Nevertheless, even if these cannot be avoided - still get tested! 

After the Pap test

If the results are normal, hooray! See you in 3 years!

But be sure pay attention to:

• Continuous vaginal discharge that is excessive or different (ex. pale, watery, pink, brown, bloody, or foul-smelling discharge)

• Abnormal vaginal bleeding between periods or after sex

• Any bleeding after menopause

If the results are abnormal, your health care provider will contact you and the Ontario Cervical Screening Program will also send you a letter. This does NOT mean you have cervical cancer. But you will have to have a discussion with your healthcare provider and repeat the test in 6 months. You may also need to see a specialist for other tests such as an HPV test. 

What's next?

If you have yet to have a Pap test and you're over 21 and have been sexually active, book an appointment! If it's been over 3 years since your last test, book an appointment! If you can't remember when your last test was, book an appointment! 

Easy right?

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