Screening uses specialized tests to find potential health issues or conditions before symptoms appear. The earlier cancer is found, the easier it is to treat.  It’s important to get screened using a Pap test regularly because the risk of getting cervical cancer doesn’t decrease with age — getting screened can save your life.

It’s important to begin having regular Pap tests starting at age 25, or 3 years after becoming sexually active, whichever is later. For example:

• If you’re 17 and are already sexually active: You don’t need to start having Pap tests until you’re 25.
• If you’re not sexually active until 25: You don’t need to start having Pap tests until you’re 28.

Remember that being sexually active doesn’t mean only intercourse. It refers to any skin-to-skin contact in the genital area, including touching, oral sex or intercourse with a partner of any sex. Once you start having Pap tests, you should continue having them until you’re at least 69 years old, even after you’ve been through menopause. Some women may feel they don’t need Pap tests. But you should still have regular Pap tests even if:

• You feel healthy and have no symptoms of cervical cancer
• You’re no longer sexually active
• You’ve only had 1 sexual partner
• You’re in a same-sex relationship
• You’ve had the HPV vaccine
• You’ve been through menopause
• You have no family history of cervical cancer
• You’ve had a hysterectomy and still have your cervix*
• You’ve had cervical cancer in the past

*If you’ve had a hysterectomy, speak to your healthcare provider about whether you still need to be screened.

No matter what, if you’ve ever been sexually active, it’s never too late to start having Pap tests.

How often should I have a Pap test?

Unless your healthcare provider tells you otherwise, here are some guidelines:

• After your first Pap test, plan to have a Pap test once every 3 years: Screening every year gives very little extra protection compared to having a Pap test every 3 years. Having Pap tests too often can lead to diagnosis of cell changes in the cervix that would likely go away on their own. This results in follow-up testing that isn’t needed.
• After age 70, you can stop having Pap tests if:
  • Your last 3 tests, done within the past 10 years, were normal
  • You haven’t had any serious abnormal cell changes in the past
  • You had an HPV reflex test result that was negative

If you experience any changes between Pap tests, such as bleeding between periods, after sexual intercourse or after menopause, tell your healthcare provider right away.

Do I Really Need a Pap Test [brochure]

A Pap test is the main screening test for cervical cancer in Alberta. A Pap test (or what some used to call Pap smears) checks the cells of your cervix, to make sure there are no abnormal cells. Abnormal cells can change over time and become cancerous without pain or symptoms. It’s a quick test done in your healthcare provider’s office or at a women’s health clinic. A sample of cells is taken from your cervix and sent to the lab. The lab checks the sample for any abnormal cells that may lead to cancer. A Pap test doesn’t test for other cancers or sexually transmitted infections such as chlamydia, gonorrhea or human immunodeficiency virus (HIV).

Pap tests only take a few minutes and are done right in your healthcare provider’s office or at a women’s health clinic.

How should I prepare for a Pap test?

Before your Pap test, here are a few things to keep in mind:

• Try to make your appointment for a day when you won’t have your period. If you have any abnormal bleeding, make an appointment with your healthcare provider right away.
• Don’t douche or use contraceptive creams or jellies in the 24 hours before the test.
• Don’t have sexual intercourse in the 24 hours before the test.
• Avoid using personal lubricants in the 48 hours before the test.

How is a Pap test is done?

You’ll be given a gown or sheet and asked to undress from the waist down. Typically you’ll be asked to lie on your back on an examination table and put your feet up on stirrups or to bend your knees. Your healthcare provider will then gently insert an instrument, called a speculum, into your vagina so that the cervix can be seen. A small spatula or brush will then be used to collect a sample of cells from your cervix to send to the lab. While you may feel a little discomfort, it shouldn’t be painful. It may help to take a few deep breaths to relax and reduce tension in your body. Your sample will then be sent to the lab to be examined.

Your Pap test results will be sent directly to your healthcare provider and you’ll receive a result letter by mail from the Alberta Cervical Cancer Screening Program in Alberta Health Services. It’s normal to feel a little nervous or unsure about having a Pap test.  Talking to your healthcare provider first may help to put you at ease.

Watch this short video to learn more about what to expect during a Pap test (Credit:  BC Cancer Agency) 

As with any procedure, there are both benefits and risks; you might think of these as pros and cons. It’s important to be aware of them before having any test so that you can make an informed decision. While no screening test is 100% accurate, scientific evidence shows that having regular Pap tests lowers your risk of dying from cervical cancer.

Benefits of getting a Pap test

• Regular Pap tests check for cervical cell changes, which can be followed closely to make sure they clear up.
• 90% of cervical cancer can be prevented with early treatment.
• If abnormal cells are found, they can be treated early, which may mean less treatment and less time spent recovering.
• The earlier cervical cancer is found, the better your chance of survival.

Risks of getting a Pap test

Pap tests are generally very safe. However, as with any procedure, there are some risks.

• There’s a chance the Pap test can miss abnormal cell changes, even when they’re present (false negative).
• There’s a chance the Pap test can suggest abnormal cell changes, even when there are none (false positive).
• When abnormal cell changes are found, some women may receive more tests or treatment even though the cell changes may never have developed into cancer.

Given how important it is to find cancer early, the benefits of having a Pap test outweigh the risks. However, it’s your decision. It’s always best to talk to your healthcare provider if you have any questions or concerns about the benefits and risks of Pap tests.

All you have to do is make an appointment to have a Pap test at your healthcare provider’s or at a women’s health clinic. If needed, you can visit Where to Get Screened to find a location close to you to have a Pap test.

This section is being updated frequently based on stakeholder consultation and emerging evidence. Latest update May 2022

Who is eligible for cervical cancer screening?

If you have a cervix and 25 years or older or ever had sexual contact, it’s important to think about cervical cancer screening no matter where you are in your transition or regardless of your gender identity. Talk to your healthcare provider about what’s right for you.

Sexual contact includes any skin-to-skin contact in the genital area, including touching, oral sex or intercourse with a partner of any sex, or sex with sex toys.

The information below is a guide for whether screening may benefit you.

If you’re 25 – 69 years

Some things to consider:

You may be at a higher risk of cervical cancer if you have a history of human papillomavirus (HPV) infections or have a condition that weakens your immune system, like HIV.

• If you’ve had bottom surgery, there’s a small risk that cancer can develop in the tissues of your neo-vagina or neo-cervix. For this reason, it’s important to talk to your healthcare provider and consider having regular Pap tests.
• If you haven’t had bottom surgery, you’re not at risk of developing cervical cancer. There is not much information about cervical cancer in trans women because the risk of cancer depends on the type of tissue used to create your vagina and cervix.
• If you’ve had a hysterectomy, that left your cervix intact, you should have regular Pap tests.
•  If you’ve had a complete hysterectomy, that included the removal of your cervix and you have no history of abnormal Pap tests, you may not need regular Pap tests.
•  If you’ve had a complete hysterectomy that included the removal of your cervix and you have a history of abnormal Pap tests, you may still need regular testing. Similar to a Pap test, a sample of cells is taken from your vaginal vault and sent to the lab for testing (sometimes referred to as a vault smear).
• If you’re taking testosterone and still have a cervix, you should still have regular cervical cancer screening. Testosterone can sometimes cause changes in the cells of your cervix that look like pre-cancerous cells. It’s very important that your healthcare provider and the lab know that you’re taking testosterone because hormones can affect your Pap test results.
• If you identify as lesbian, bisexual, or a woman who has sex with women and you have a cervix, you should still have regular cervical cancer screening.

It can be difficult to make cervical screening a priority, especially if you’re concerned about experiencing discrimination. All patients have the right to receive healthcare without discrimination. Talk to your healthcare provider about your personal screening needs and ways to make screening more comfortable for you.

Remember to have Pap tests once every 3 years, even if:

•  You’ve only had one sexual partner
• You’ve had the HPV vaccine
• You’ve been through menopause
• You’re no longer sexually active
• You feel healthy and have no symptoms of cervical cancer