Cervical Screening: Smear Test and HPV Testing Explained
Cervical cancer screening: when to start, how often to test, what ASCUS, LSIL, HSIL and HPV-positive results mean, colposcopy and treatment.
Op. Dr. Sadık Kükrer, MD
Obstetrician & Gynecologist · Adana, Türkiye
Cervical cancer is one of the few cancers that regular screening can prevent. Almost all cases result from persistent high-risk human papillomavirus (HPV) infection, and progression to cancer usually takes years. The smear test and HPV testing allow pre-cancerous change to be detected early within that window.
Smear test versus HPV test
- Smear (cytology): shows whether cervical cells have undergone abnormal change.
- HPV test: detects high-risk HPV types capable of causing cancer; HPV 16 and 18 may be reported separately.
- Both can be run on the same sample. HPV testing is more sensitive than cytology alone, and a negative result offers long-term reassurance.
Who should be screened, and how often?
Türkiye's national programme offers HPV testing with cytology every five years to women aged 30–65, free of charge at KETEM centres and family practices. International guidelines describe screening from age 21–25. Women living with HIV, transplant recipients and other immunosuppressed women require more frequent screening. Screening may stop after hysterectomy with removal of the cervix if there is no history of abnormal results.
Preparing for the test
- Book it outside your period, ideally a few days after bleeding ends.
- Avoid intercourse, douching, vaginal medication and lubricants for 48 hours beforehand.
- A smear can be taken safely during pregnancy.
Understanding your results
- HPV negative, normal cytology: repeat screening in five years.
- HPV positive (non-16/18), normal cytology: usually repeat testing in one year; most infections clear in that time.
- HPV 16 or 18 positive: colposcopy is advised even with normal cytology.
- ASCUS / LSIL: surveillance or colposcopy according to HPV status.
- ASC-H / HSIL / AGC: colposcopy and biopsy, with treatment where needed.
Colposcopy and treatment
At colposcopy the cervix is examined under magnification and small biopsies are taken from areas highlighted by acetic acid. If a high-grade pre-cancerous lesion (CIN 2–3) is found, the abnormal tissue is removed under local anaesthetic with a fine wire loop (LEEP / conisation). The uterus is preserved and follow-up continues with HPV testing.
Prevention
Regular screening, the HPV vaccine, condom use and stopping smoking substantially reduce the risk of cervical cancer. Vaccinated women should continue screening. Abnormal bleeding, particularly after intercourse, should be assessed without waiting for the next screening appointment.
Op. Dr. Sadık Kükrer, MD provides cervical screening, colposcopy and follow-up in Adana, Türkiye.
Frequently asked questions
What is a smear test?+
A sample of cells is taken from the cervix with a soft brush and examined under the microscope to detect pre-cancerous change. HPV testing can be performed on the same sample. The procedure takes a few minutes and is usually painless.
When and how often should I be screened?+
Türkiye's Ministry of Health programme offers HPV testing with cytology every five years to women aged 30–65, free of charge at cancer screening centres (KETEM) and family practices. International guidelines recommend starting with cytology at 21–25 and moving to HPV-based screening every five years from 25–30. Immunosuppressed women need more frequent screening.
How should I prepare for the test?+
Book it outside your period. Avoiding intercourse, douching, vaginal medication and lubricants for 48 hours beforehand improves the reliability of the result.
My HPV test was positive. Do I have cancer?+
No. HPV is extremely common and most sexually active people encounter it at some point. The great majority of infections are cleared by the immune system within one to two years. What matters is long-term persistence of high-risk types, so follow-up is tailored to the HPV type and cytology result.
What do ASCUS, LSIL and HSIL mean?+
ASCUS means atypical cells of undetermined significance, LSIL low-grade squamous intraepithelial change and HSIL high-grade pre-cancerous change. ASCUS and LSIL are usually managed by surveillance or colposcopy according to HPV status; HSIL warrants colposcopy and treatment where indicated.
What is colposcopy, and is it painful?+
It is examination of the cervix with a magnifying instrument. Acetic acid is applied to highlight abnormal areas, from which small biopsies may be taken. It is performed like a smear test and takes 10–15 minutes; a brief cramp may be felt during biopsy.
Do I still need screening if I have had the HPV vaccine?+
Yes. The vaccine provides strong protection against the HPV types that most often cause cancer, but not against all of them. Vaccinated women should continue age-appropriate screening.
Would you like to book a consultation?
For pregnancy monitoring, women's health, and gynecologic surgery in Adana, get in touch with Op. Dr. Sadık Kükrer.
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