126. Cervical Cancer Screening Made Simple: What to Do and When

January is Cervical Cancer Awareness Month, and this episode is your clear, evidence-based guide to screening—without fear or confusion. Dr. Monica Minjeur breaks down what cervical cancer screening does (and doesn’t) test, when to start, how often to screen, and what’s changed with newer options like HPV-based testing and emerging self-collection pathways. You’ll also learn how abnormal results are usually manageable, why screening protects fertility by preventing more invasive treatments later, and what symptoms should prompt an evaluation even if you’re “not due” for a Pap.

If you’re overdue, trying to conceive, or want a personalized plan, schedule a free discovery call with Radiant Clinic at radiantclinic.com to learn how we support whole-person hormone and fertility health—locally in Cedar Rapids or via telehealth in many states.

Transcript

Speaker: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if a single 10 minute appointment could prevent a cancer that's almost entirely avoidable and protect your future fertility choices? January is Cervical Cancer Awareness Month. So today we're going to be talking about the latest screening guidelines for cervical cancer, the real reason to screen and how this connects to cycle health and fertility in some practical evidence-based steps. So let's get started as always, with a story about a patient who we'll call Kayla now. Kayla came to see us at 32 years of age, and she was a busy teacher. She had recently gotten off of the birth control pill and had started charting her cycles. She told us, I feel great. I haven't had a pap smear in about seven years. Do I really need one? I'm otherwise low risk screening felt optional to her since she had no symptoms and her pap was normal previously. However, a close friend of Kayla's recently had their pap test done, and she was diagnosed with high grade cervical changes. After skipping some of her screenings during the 2020 pandemic, Kayla scheduled her follow-up visit to get her PAP test completed. We reviewed her options for screening and since she was older than 30, one of the options is to include HPV testing along with a pap smear if it's both negative. At the time only testing every five years is a reasonable alternative. We also offered her the option to do a self collected HPV test, and this is a little bit less sensitive, but is a better option than doing nothing at all. Kayla chose to have the PAP testing with HPV, and since everything was negative, we gave her a five-year low risk window and some peace of mind. She set a reminder for her next screening and updated her charting app with the result and left with an understanding of why this matters, even when she feels well. So let's talk a little bit about what cervical cancer is, what it isn't, how we screen for it, and what's changed recently. So it's important to understand that when we are talking about cervical cancer or a pap smear, this is truly just looking at the cervix, which is kind of the end part of the uterus itself. Pap testing does not check for uterine. Vaginal or ovarian cancers. And these cancers are best diagnosed with physical examination with your doctor and sometimes additional ultrasound screening if you have certain symptoms. Now, most cases of cervical cancer are caused by a persistent infection with high risk HPV or human papillomavirus. HPV causes nearly all cervical cancers. And screening with a PAP test helps to find pre-cancerous changes early when it's easiest to treat. So when I talk to my patients about our results that we see on a PAP test, they can range on a big spectrum. So it starts anything from normal to abnormal cells of undetermined significance to clinical signs of changes with the cell. That's a grade one. Higher grade, which is a grade two, and then we talk about low grade, high grade squamous cell intraepithelial lesions and then progressing onto cancer. So there's lots of different steps along the way that we can catch those early changes before they get the chance to progress onto cancer. So the different types of testing that we're looking at, most people are aware of have heard about the PAP test. So this typically involves using a little brush or it looks like a broom, and we just gently scrub across the top of the cervix itself. So that's the PAP test. Then there's HPV testing, and this almost always is collected in a similar way to the PAP test, and in fact can be run off of the same sample that's completed with a PAP test. So the current recommendations have been changing a little bit, and in the past year there were some new updates. So every society that talks about cervical cancer screening has a little bit different guidelines, but in general, the recommendation is to start screening for cervical cancer with a PAP test at age 21. No need to start screening prior to that, even if you have been sexually active prior to that age. And in part that's because in many young women under the age of 21, even if they're exposed to HPV, they're able to clear that infection a bit more easily. So we don't typically start testing a pap smear prior to age 21 for that reason. Now, between the ages of 21 to 29, typical recommendation is to complete a PAP test every three years. Now oftentimes if there is anything abnormal with the pap test, then there will be a follow-up test done to check for HPV. After age 30, generally the recommendation and my preference is, is to complete a PAP test plus HPV screening. If you do both of those together and they're both negative, then you only need to repeat a PAP test with HPV every five years. So one of the things that's a bit newer, like I mentioned this past year, is that there is another option for people who don't wanna do the pap test, can't get there, refuse to go and have a a vaginal exam done. And that is the option for a self swab collection to check for HP. Now the recommendation for this is that this should only be done if you are unable to get a PAP test done because they do say that a doctor collected specimen is still going to be more accurate and more sensitive. But again, it is an option to do a self collection swab at home. Send it in and get that checked to see if you have HPV. Now certainly if that is abnormal, you will require additional follow up, but it is a good first step for people that have maybe had no other screening done or are hesitant to do any screening altogether. And in my books, it's better than doing nothing. So that has been an added option for most ages starting at age 25. Now, some societies will still recommend that you don't do those self collected HPV samples until age 30 and continue to do PAP testing across the board. But I did wanna talk just a little bit about that self collection of HPV, because that is a brand new recommendation within the past couple of months here in late 2025. So. Recommendations. Options including home self collection of an HPV swab. Again, probably less recommended, but again, better than nothing. PAP testing alone for women, ages 21 to 29, and then co testing of PAP plus HPV testing starting at age 30. Now, when do we get to stop PAP testing? Generally, most guidelines will recommend that you can stop pap smear screening for cervical cancer at age 65 if you have had adequate negative prior screening. So meaning you've kept up to date on your paps, and there's been no history of higher grade lesions in the past 25 years. If you have had a hysterectomy and your cervix was removed for benign reasons and there's no prior history of higher grade lesions, routine screening can stop at that time. However, some women with a hysterectomy still have their cervix intact, and so if you still have a cervix, it is incredibly important to understand. You must still continue with PAP testing. So again, very important to understand if you've had a hysterectomy. Which parts may or may not remain because not all hysterectomies remove all the same parts. I'd also like to add in that even if you are not getting your PAP test done on a regular basis, it is incredibly important to still get your annual exam. Most women know or feel like I've got it checked off the list when I actually had that pap smear done, but your annual exam encompasses. So much more. We go over everything that's going on with your health. We talk about breast exams, mammogram screening. If you're in need of that, we look through labs, evaluate your hormone panel if needed. So still incredibly important to get that annual exam even if you're not due for a PAP test that year. So what are some signs or symptoms of cervical cancer? Most women have absolutely no symptoms, and that is quite common, especially as we see early changes. This is why it's so important to get screening on a regular basis because oftentimes there's nothing major that's gonna show up. If you have later signs of cervical cancer, this could be a cause for bleeding that is irregular. So whether that's bleeding in between your menstrual cycles, bleeding after intercourse, persistent discharge, pelvic pain, important to get checked just to make sure everything is up to speed. Now, we're gonna talk about in the next few weeks, other reasons for abnormal bleeding. So please hear me. Not all abnormal bleeding is cancer, but it is important to make sure that we have ruled out anything more scary in order to be able to check that off the list. I would also add in a couple of special situations here. You are going to be at higher risk and typically going to need closer or more frequent follow up if you are currently on immunosuppressive medications, so either chronic steroids or medications to treat significant autoimmune dysfunctions. If you have HIV or other immune deficiencies, if you're a chronic smoker or if you've had a history of inadequate prior PAP test screenings or a history of higher grade lesions or changes with that cervical testing. If you have any abnormals that show up, there is a very specific outline as far as what needs to be done, what additional testing is completed. If you've been vaccinated with the HPV vaccine, it does reduce your pre-cancer or cancer risk, but it does not eliminate your need for ongoing cervical cancer screening. So important to know that if you are somebody who has had the vaccine, you still have to continue with regular cervical cancer screening. So what about screening for cervical cancer and fertility? What's the connection? Screening itself does not harm fertility, as I mentioned, we are not doing any sort of sampling that goes up high into the cervix or into the uterus itself. Again, literally just brushing across the surface of the cervix, and again, with the goal to prevent. Additional disease that could require additional treatments, which can be problematic for fertility. So in women who develop a pre-cancerous lesion or significant changes, there is a need to go through some sort of treatment for that. Now, depending upon your results, that may require cutting out a small portion of the cervix itself. And there are some studies that show a modest increased risk of preterm birth after you have had an excisional procedure where they've removed part of your cervix. Now, data is mixed, but we do take this very seriously. So we want to say, let's avoid needing to get to that point by keeping up to date on the regular screenings, treating it, dealing with it before it gets to that more significant stage where more intense treatment is required. So what can you do this month? First of all, know your status. When was your last PAP screening? What test did you actually have done? Was it just a PAP test? Was HPV checked? Did you even have a pap completed or was it just a vaginal, pelvic exam? What were your results? From there, we'll choose particular paths. So again, between the ages of 21 to 29, typically recommending a pap smear every three years, there are other guidelines and recommendations that can be followed. So discuss this further with your doctor who's performing your testing from age 30 to 65. Again, options including pap test every three years, if that's the only testing you have done. Or you can do co testing where you're checking for Pap plus HPV, and if that's normal, repeat every five years, and then the self collection as an option basically at any age after 25. So in clinic, self collection is supported. At-home devices are emerging, so check on availability or coverage. But again, self collection in my estimation, should only be done if there's a significant reason that you are unable to complete the PAP and HPV testing with a physician because those are going to be higher sensitivity. If you are actively trying to conceive, continue to screen on schedule. This helps to protect future pregnancies and helps to hopefully catch things before they get to a problematic stage where something more significant would need to be done. One note on that, if you are pregnant and it has been a long time since your last PAP test was done, it is safe and okay to complete PAP testing. During pregnancy, as long as you don't have problems with cervical shortening or if you are not actively bleeding, if you happen to have an abnormal result on any of your Pap testing at any point in time. First and foremost, do not panic. Most abnormalities that we find on PAP testing are not cancer and are manageable with different treatment options. Again, your doctor will go through with you what your next steps for screening and follow up look like, as well as additional evaluation, which sometimes can involve a biopsy of the cervix or sometimes just a more thorough investigation and visualization to make sure there is not something more serious going on. So just a reminder, can you stop screening at age 65? Yes. As long as you've had adequate negative prior tests and no problematic cells within the past 25 years after hysterectomy. Depends upon if you have a cervix or not. If your cervix is removed and there was no problems or concerns for cancer, then screening may stop. If you still have a cervix, then you must continue screening if you're vaccinated. Against HPV, yes, you still need to complete screening and does screening hurt fertility or create issues? No. Screening itself is not problematic, but treatment of significant larger lesions can carry a slight increased risk of preterm birth risk later on. So that's why it's appropriate and not excessive intervention that matters. Imagine if your cervical cancer screening plan felt simple and personalized, that you knew what was the one best test for you at the right interval. With options that fit your life and time and schedule over the coming years, you would be able to prevent a nearly always preventable cancer, protect future pregnancy plans and carry genuine peace of mind to improve your health and promote fertility.

Speaker 2: 15:57

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.