About the Pap test

The Papanicolaou test, also called the Pap test or cervical cytology, is a cervical cancer screening test. It allows for the detection of abnormal cells that could become precancerous lesions that could then turn into cervical cancer. This test has been widely used in Quebec for a long time. Having a Pap test is a personal choice. It is important to learn the advantages, disadvantages and limits of this screening so that you have all the information you need to make an informed decision (see a list of the advantages, disadvantages and limits below).

Screening frequency and eligible persons

In the regions where it is offered, Pap test screening is recommended every two to three years for eligible persons, including asymptomatic persons who meet the following criteria:

  • Are between 21 and 65 years old;
  • Have a cervix, regardless of gender identity;
  • Have been sexually active (including any genital contact with or without penetration);
  • Not presenting symptoms sometimes associated with cervical cancer (see below);
  • Be insured by the Québec public health insurance plan.

The health professional recommends to people over 65 years old that they continue or stop screening depending on their particular situation and the results of their most recent screening tests. Those who are not eligible are encouraged to read about the measures for preventing the spread of HPV and other sexually transmitted and blood-borne infections (STBBIs).

Those who present symptoms sometimes associated with cervical cancer (for example, vaginal bleeding, particularly after sexual intercourse or abnormal vaginal discharge) are not part of the target population for this screening program. They must contact a doctor and undergo a medical follow-up based on their situation.

Screening test procedure

The screening must be conducted by a health professional during a gynaecological exam. It only takes a few minutes. The health professional first inserts a speculum in the vagina to hold the vaginal walls apart. This makes it easier for the health professional to see and reach the cervix at the upper end of the vagina. Using a small brush, the health professional lightly swabs the surface of the cervix to take some cells. The sample is then sent to the laboratory for analysis. Once the results are received, the health professional provides the appropriate follow-up (see the Screening results section).

Advantages, disadvantages and limits of screening

It is important to learn the advantages, disadvantages and limits of screening so that you have all the information you need to make a decision. Having the screening done is a personal choice. Each person can make an informed decision on whether to undergo screening, according to their values and preferences. It is normal for some people to accept, while others refuse or wait to undergo screening. Here are a few things to think about while making your decision. You can talk to a health professional about them, if needed.

Advantages

People aged 21 to 65 years old who undergo a Pap test every two to three years can:

  • reduce the risk of developing cervical cancer;
  • reduce the risk of dying from cervical cancer because it allows for the detection of abnormal cells or cancers at an early stage. It is then possible to remove the affected part of the cervix.
  • 10 out of 1,000 people who do not participate in the screening could die of cervical cancer.
  • 2 out of 1,000 people who participate in the screening could die of cervical cancer.

    Therefore, there would be 8 fewer deaths associated with cervical cancer for those 1,000 people who underwent the screening.

Disadvantages

However, there are some disadvantages for the people aged 21 to 65 years old who undergo a Pap test every two to three years:

  • waiting periods and worry, for example, when additional tests are needed to confirm the screening results, such as a colposcopy. However, most of the time the results of the colposcopy are normal;
  • discomfort (ex., insertion of the speculum) or light bleeding during screening, and sometimes pain caused by additional tests (ex., colposcopy);
  • possibility of overdiagnosis. Overdiagnosis is discovering a cancer that never would have been detected without the screening, and that never would have had an impact on the person’s health or life, for example, a cancer that develops very slowly or an indolent cancer. Since it is not yet possible to distinguish indolent cancers from fatal cancers, they are all treated. Therefore a person who undergoes screening might:
    • have to live with a cancer diagnosis,
    • have frequent medical appointments to ensure that the cancer does not reappear,
    • feel anxiety about this cancer;
  • possible overtreatment. A person who undergoes screening might:
    • receive treatments that might not have been necessary,
    • experience side effects of additional tests and treatments;

    The colposcopy can reveal the presence of abnormal cells. These cells could develop into cancer, but not necessarily. Since it is impossible to know in advance, the part of the cervix containing abnormal cells must be removed as a precaution. Therefore, some people might have part of their cervix removed “for no reason.” This situation most often affects younger people. Removing part of the cervix can increase the risk of premature birth in subsequent pregnancies. For example, a person who has undergone this procedure might give birth before the 34th week when a full-term birth is between 37 and 42 weeks. One in every 100 people who have had this procedure is at risk of premature birth.

Number of people who require a colposcopy after screening
Age at the time of screeningNumber of people who get a colposcopy (out of 1,000 people who have been screened)

20 to 29 years

60

30 to 39 years

26

40 to 49 years

17

50 to 59 years

10

60 years or older

6

Number of people who need a part of their cervix removed after the colposcopy
Age at the time of screeningNumber of people who need a part of their cervix removed due to the presence of abnormal cellsNumber of people who have a part of their cervix removed even though the abnormal cells would never develop into cancer

20 to 29 years

13 (out of the 60 who underwent a colposcopy)

9 (out of the 13 who had part of their cervix removed)

30 to 39 years

7 (out of the 26 who underwent a colposcopy)

5 (out of the 7 who had part of their cervix removed)

40 to 49 years

4 (out of the 17 who underwent a colposcopy)

3 (out of the 4 who had part of their cervix removed)

50 to 59 years

2 (out of the 10 who underwent a colposcopy)

1 (out of the 2 who had part of their cervix removed)

60 years
or older

1 (out of the 6 who underwent a colposcopy)

Less than 1

Limits of screening

Participating in cervical cancer screening does not guarantee that:

  • all cervical cancers will be detected;
  • all people who have this cancer will survive it.

Some of the people who receive a normal result on the screening test or on additional tests will develop cancer anyway. This situation can arise if:

  • the cancer was invisible or was not detected;
  • the cancer had not yet developed at the time of screening.

It is impossible to know, at the time of screening, exactly who will experience advantages or disadvantages.

Having a Pap test

To undergo a Pap test, consult a health professional. Family medicine groups (GMFs), local community service centres (CLSCs) or clinics offer this service. Contact these resources to find out if you can get a Pap test. Their contact information is in the Finding a resource section.

Self-sampling for a Pap test is not available in Québec.

Screening results

Two main results are possible:

  • Negative result: the screening did not detect an abnormality that requires specific follow-up. If you are still eligible, it is recommended that you undergo a Pap test every two to three years (or an HPV test in three years when this test becomes available in your region; see the tab on the availability of tests by region).
  • Positive result: the screening detected an abnormality (abnormal cells or a precancerous lesion). This does not mean that you have cervical cancer. This result means that follow-up or additional tests are needed to clarify the results. The choice of additional tests and follow-up can vary for each person.

The results are available from the health professional who performed the test, in some cases in your Québec Health Booklet This hyperlink will open in a new window. after at least one month or in your medical file at the institution where the test was performed.

Additional tests

Based on the results obtained on the Pap test, the health professional might need more information to clarify the screening test results. Additional tests may be requested, such as:

  • an HPV test: it confirms the presence of the human papillomavirus, which increases the risk of developing cervical cancer. This test also helps the health professional to determine whether a colposcopy is necessary;
  • a colposcopy: consists of observing the cervix to look for lesions. It takes about 10 minutes. The doctor uses a speculum and a colposcope to get an enlarged view of the cervix, as with a magnifying glass. The doctor applies a solution to the cervix that makes it easier to see lesions with the colposcope;
  • a biopsy: when a lesion is observed during the colposcopy, the doctor will proceed with a biopsy. This procedure consists of taking a small sample (three to five millimetres) of the surface of the lesion. The sample is then analyzed in a laboratory to determine whether it contains precancerous or cancerous cells.

Last update: November 6, 2023

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