More questions
I just had a Pap-smear taken for other purposes, should I still take part in screening?
It is always worth your while to take part in screening, even if you have had a recent Pap-smear elsewhere.
The quality and reliability of organised screening programmes (provided by the municipalities) are continuously monitored and assessed by law. This kind of quality assurance is not required from screening tests outside the organised programme. For this reason, it is recommended that women aged 30-60 have their Pap-smears taken first and foremost within the organised screening programme. If you have never had an abnormal Pap-smear result, and you have no abnormal symptoms (for example vaginal bleeding that is not associated with menstruation), taking a Pap-smear every five years is usually enough.
I have had a hysterectomy, should I take part in screening?
If the cervix was removed along with your uterus, cervical cancer can naturally no longer develop. Taking part in screening is still worth your while, because abnormalities can develop also in the cells lining the vaginal walls and vulva, and these cell abnormalities can also be detected in tests taken at screening visits.
If the hysterectomy was performed because of cervical cancer of its precursor, regular screening is highly recommended. Previous cell abnormalities or cancer precursors of the cervix increase also the risk of developing vaginal and vulvar cell abnormalities. Also, if the cervix was left intact at the time of the hysterectomy, screening is necessary.
Can I take part in screening while pregnant?
Sample taking is not harmful for pregnancy or the fetus, thus pregnancy does not prevent from attending screening. Only pregnancies with a risk for preterm labour can make an exception to this.
How soon after delivering a baby can I take part in screening?
A Pap-smear can be taken as soon as 1 to 3 months after labour, if recovery has progressed smoothly. The smear can be taken while still waiting for your menstrual cycle to get going, as well as while breast-feeding.
I have been vaccinated against HPV, should I still take part in screening?
Regular Pap-smears are necessary also among those women that have been vaccinated against HPV. The vaccinations are only effective against a few HPV-types; they do not prevent all HPV-infections.
I’m undergoing cancer treatments (radiation therapy, cytostatics), can I take part in screening?
A Pap-smear can be taken during radiation therapy or cytostatic treatments, but a notion on the treatments must be recorded in the screening form.
I use vaginal medications (medication for yeast, vaginal antibiotics, vaginal hormonal preparations), can I take part in screening?
Vaginal hormonal preparations (Vagifem etc) or off-the-counter vaginal medications (Lactasil, Gynocaps, Vagi-C tms) do not prevent from taking a Pap-smear. If you are using vaginal yeast medications or antibiotics, it might be a good idea to wait until the course is over before taking part in screening (post-pone the appointment if needed). A smear taken after the course can also tell you if the treatment was successful (act as a follow-up test).
What is the screening sample analysed for?
The screening sample is usually analysed using the traditional Papanicolau (Pap)-test. In some municipalities a part of the samples are analysed for the presence of human papillomavirus DNA. Both screening tests are safe, reliable and sensitive. In those municipalities where the HPV test is in use, women are randomly selected to HPV testing or traditional Pap testing from all invited women before invitation.
What is an HPV test?
Human papillomavirus (HPV) test identifies women that are in the highest risk of having or developing cytological abnormalities. HPV is considered the necessary but not the only cause of cervical pre-cancerous lesions and cancer. A long-term infection with HPV causes cytological abnormalities of which a small part progresses to pre-cancerous lesions and a very small part further to cancer. The HPV test detects the infection caused by these viruses. The HPV test is positive, i.e. the screening sample includes human papillomavirus, in less than one out of ten samples.
What is a human papillomavirus?
HPV or the human papillomavirus is a mainly sexually transmitted virus. It is very common and the majority of people will have an HPV infection at some time of their lives, usually during early years of sexual activity. Even using a condom does not prevent from the HPV infection completely. The time and source of the infection cannot be reliably identified. For these reason, HPV is generally not considered as a true sexually transmitted infection (STI).
Where are the screening samples analysed?
Screening samples are analysed in screening laboratories. There are currently 15 of them in Finland. They are either private or owned bythe municipalities themselves.
How are women notified about the result of their screening test?
The result of the screening test will be sent home in a personal letter for all women that have attended screening. In nine out of ten cases the result of the screening test is reported simply as being normal.
Sometimes an abnormal test result may be notified using abbreviations. Such are ASC-US, ASC-H, LSIL, HSIL and AGC-NOS, AGC-FN. Of these, ASC-US and AGC-NOS represent borderline cytological abnormalities that indicate a need for controlling by a new Pap test. In case of an ASC-US women are usually invited for intensified screening within one to two years. ASC-H, LSIL, HSIL and AGC-FN represent more severe cytological abnormalities and indicate a need for further examinations, usually colposcopy and biopsies. However, LSIL in women younger than 30 years can also be controlled by repeated Pap testing and decision on referral for colposcopy depends on the recommendation by the cytopathologist. In case of a need for further examinations or treatments this is clearly stated in the response letter. Even in that case, however, most of the abnormalities are not related to pre-cancerous lesions or cancer.
If the result of the HPV test is positive, it is generally enough to control that the HPV infection heals on its own. If the HPV test result is positive, the screening sample will also be checked for cytological abnormalities (the Pap test). In case of a normal Pap test result the women are invited for a new screening visit within one to two years. However, if the Pap test detects cytological abnormalities requiring further examinations, the women may be referred for them (see above).
What are the further examinations like?
Nearly always the further examinations mean colposcpy, i.e. an endoscopy of the vagina and cervix. The colposcopy is done at the outpatient clinic in the hospital and histological samples can be taken if needed for the confirmation of the diagnosis.
