Cervix exam and Pap test

Pap test - What is it, where and how is it taken, cell changes, test results and the cervical screening program (2022)

The doctor or gynecologist performs a regular gynecological examination of the genitals, and uses a small brush to collect cells from the cervix. It can be a little uncomfortable and can bleed a little afterwards, this is completely normal. It takes a few minutes and is an important factor in detecting cancer or pre-stages of cancer at an early stage. You can prepare yourself by not taking the test when you are menstruating, preferably avoid intercourse in the last 2 days before the test, do not use tampons or vaginal medication / cream in the last two days before the test.

Two pap test methods

The pap test will be examined using two different methods depending on the woman's age. HPV test (virus test) for women from 34 years is now gradually being introduced in Norway, while for those aged 25-34, cell changes are being investigated. This is because the incidence of cervical cancer is highest in this age group.

The two different survey methods are thus:

25 - 29 years: the sample is examined under a microscope for cell changes.
30 - 69 years: the sample is examined with an HPV test. If the sample is HPV positive (virus present), the same sample is examined under a microscope for cell changes.

NB: New guidelines for the cervix program:

After 1 July 2023, samples for all age groups (25-69) will be examined first with the HPV test. If the sample is HPV positive, the same sample is examined under a microscope for cell changes. If HPV is not detected in the test, you will be reminded of the next cervical test after five years. The reason for the change is that the HPV test is more effective in detecting the precursors of cervical cancer, compared to looking for cell changes under a microscope. Read more about the changes here.

Who should be tested and how is the test performed?

Women aged 25-69 who follow the screening program for cervical cancer are routinely tested. If you have new symptoms in the period between two screenings or at an earlier age than 25 years, contact a doctor, who will take an extra sample. Men are not tested routinely.

The test is done by an examination of the genitals where the doctor or gynecologist takes a brush sample directly from the cervix. This does not hurt, and it is common with a small bleeding / colored discharge afterwards. This sample is sent to the laboratory and tested for viruses and cell changes. It is also possible to test for HPV virus in the urine, but to look for cell changes on the cervix, a brush sample is required.

It is voluntary to take a pap test, but it is strongly recommended to do it every 3 years.

Pap test at Dr.Dropin

You can take the Pap smear at our GPs or midwives for NOK 695, or at our gynecologists for NOK 1195. The gynecologists will also carry out a full gynecological examination if you book such an appointment.

NB: New guidelines regarding pap smears mean that this is only carried out if indicated, i.e. with symptoms, or via the cervix programme. If you want to take a pap smear without an indication, there will be an additional fee of NOK 1400.

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Cell changes and cervical cancer

A long-term HPV infection in the genitals can cause something called "cell changes" which in the course of 10-20 years can develop into cancer. Cell changes are an altered structure in the cells of the cervix from normal. These changes are divided into three stages (described in the section "Test results"), and are not necessarily the same as the pre-stage of cancer. A change in the cells can return to normal, or they can change further to the precursor to cancer. Precisely because HPV infection often goes away on its own without leading to serious illness, and the fact that it takes a long time before a cell change eventually develops into cancer means that there is little point in testing for an HPV infection in women under 34. year.

Every year, about 300 Norwegian women are diagnosed with cervical cancer. Cervical cancer develops slowly through several stages from benign precursors to cancer to malignant cancer, and it takes time before you get symptoms. It is important to follow the cervical program even if the virus or cell changes are not detected, as it may occur at a later time.

It is recommended that all women of all ages, regardless of whether they have had zero or more sexual partners, be vaccinated against HPV, and follow the cervical program from the year they turn 25 years old.

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Cervical screening programme

The cervical program is an offer to all women between the ages of 25 and 69 to regularly check for cell changes in the cervix. The Cancer Registry sends out reminder letters to all women every 3 years up to and including the year they turn 69. From the age of 70, you must take the initiative for the test. This is a screening program designed to detect early stages of cancer at an early stage so that it can be treated early and prevent serious disease. It is voluntary whether you want to be examined or not, but it is strongly recommended.

The sample is examined for HPV virus as well as cell changes. Due to the slow development of any cancer, it is enough to be tested every 3 years, as no dangerous disease will develop during the 3 years.

Test results

The test results can often be a bit confusing, as many people believe that cell change is the same as the precursor to cancer. This is not true, as a cell change can also be a sign of mucosal irritation.
The test answer is divided as follows:

Normal pap test: no changes have been found and you can wait 3 years for the next sample
HPV negative: no virus found, you can wait 5 years for the next test
HPV-positive: virus has been found, and the sample will also be examined for cell changes
Mild cell changes (stage 1) detected: this is usually a sign that you have an HPV infection, and the sample is also tested for HPV. If it is HPV-positive, a new test is recommended within 6 months. The reason for waiting a while is that the body then usually has got rid of the infection in the meantime and the cells are normal again. It is not dangerous to wait this time, as it takes at least 10-15 years before a cell change can develop into cancer.
Severe cell changes (stages 2 and 3) detected: then you will be referred directly to a gynecologist for a thorough examination of the genitals and several tests. If these tests also show serious changes, you will be offered prompt treatment and follow-up.
Cervical cancer detected: if the cell sample shows cancer, you will be quickly referred in a cancer package to your local hospital where you will be examined thoroughly to find out how far the disease has come, and the doctors there will find the right treatment for you.

Expected response time

Regardless of where you perform the pap test, it usually takes up to three to four weeks to get an answer to the sample, but can sometimes take up to 8 weeks. If the doctor suspects that it may be cancer, the test will be given priority at the laboratory. The doctors at Dr.Dropin give answers in Pasientsky regardless of whether the answer is positive or negative. If the sample shows severe cell changes or detected cervical cancer, the doctor will call you and refer you directly to a gynecologist for further examination and treatment.

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Frequently asked questions

What is a cell sample and how is it done?

This is a sample that is taken from the cervix by the doctor doing an examination of the abdomen. The doctor uses a brush to collect cells from the cervix, which is then sent to the laboratory for examination.

In the past I have always had normal test results, do I still have to be checked until I am 69 years old?

Yes, it is strongly recommended that you follow the cervical program with regular examinations as it can take a long time before cell changes take place, or you can also become infected at a later time.

How reliable is the test result?

The pap test is good for detecting abnormal findings, but can give a false positive answer. In other words, a test that at first seems abnormal may turn out to be normal in a control test.
The virus test is even more accurate at finding abnormal findings, but in return gives even more false positive answers.

My test showed cell changes, why do I have to wait several months for a new test? What if I get cancer in the meantime?

If you have received a test result that shows cell changes and advised to take a new test within a few months, you will most likely only have mild cell changes. Most often this is due to an HPV infection, and your body will most likely get rid of this infection within a few months and the cell changes will disappear. It takes at least 10-15 years before a cell change develops into cancer, and it is therefore not dangerous to wait a few months to see if the cells return to normal.

Does the pap test hurt?

It does not hurt, but it can be a little uncomfortable while taking the brush sample.

Author: Dr. Anne Marte Ladim
Last updated: 23.06.2022

Sources

Helsenorge, (2019), Undersøkelse av livmorhalsen (celleprøve og kolposkopi), (online), tilgjengelig fra: https://helsenorge.no/undersokelse-og-behandling/celleprove-av-livmorhalsen-og-kolposkopi (hentet 21.05.2020)
Kreftforeningen, https://kreftforeningen.no/om-kreft/undersokelse-ved-kreft/kolposkopi/ (hentet 21.05.2020)
Norsk elektronisk legehåndbok, https://legehandboka.no/handboken/kliniske-kapitler/gynekologi/tilstander-og-sykdommer/svulster-og-dysplasi/livmorhalskreft/ (hentet 21.05.2020)
Norsk helseinfromatikk, https://nhi.no/sykdommer/kvinne/celleforandringer/celleprove/?page=5 (hentet 21.05.2020)

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