Cervical Screening:

Pap Test, HPV Test, and HPV Vaccination

Cervical cancer screening is one of the most remarkable success stories in women’s health. Unlike with many other types of cancer, we can detect not only the cancer itself at an early stage, but also its precancerous stages—often years before anything malignant could even develop. This long lead time is your greatest ally: it gives us time to monitor the situation carefully and take action only when it’s truly necessary.

HPV is almost always involved—and there’s no shame in that

We now know that virtually all malignant cellular changes in the cervix—nearly all cases, about 99 percent—are caused by human papillomaviruses (HPV) (de Martel et al. 2017). These viruses are extremely common and are transmitted through sexual intercourse—the vast majority of sexually active people will come into contact with them at some point. An HPV infection is therefore not a sign of poor hygiene or infidelity, but simply a part of life.

The good news: In about nine out of ten cases, the immune system clears the virus on its own within about two years, without any complications ever arising (FOPH). Only if an infection with certain high-risk types persists for years can precancerous lesions develop at all. It is precisely these rare cases that we aim to detect early through screening.

Get vaccinated before the virus strikes

The HPV vaccine offers the most effective protection. It targets the virus types most commonly associated with cervical cancer and is most effective when administered before the first exposure to the virus—that is, generally before the first sexual intercourse. It is recommended for girls and boys alike, generally between the ages of 11 and 14, since HPV affects both sexes. In Switzerland, the vaccine is provided through cantonal vaccination programs and is currently exempt from the deductible; even those who did not have the opportunity to get vaccinated as teenagers can still receive it up to age 26—just ask us about it (FOPH).

And even if you’ve been vaccinated, you should still get screened: The vaccine protects against the most important high-risk types, but not all of them. That’s why the Pap test remains important.

What We Test for and When

During a Pap smear, we use a soft brush to collect a few cells from the cervix and have them examined in the lab. It only takes a moment and usually doesn’t hurt. Which screening is appropriate depends on your age: We generally start at age 21 and repeat the Pap test approximately every three years as long as the results are normal—based on current knowledge, an annual Pap test is not necessary. Starting at age 30, an HPV test—which directly screens for the virus—may also be advisable. However, this primary HPV testing is not currently covered by basic health insurance—we’d be happy to discuss the method and costs with you (SGGG, Expert Letter No. 50).

Why we’d still like to see you every year

Just because the Pap smear is only needed every few years doesn’t mean your appointment with us should be only every few years. An annual checkup makes sense for many other reasons: for a breast exam, to discuss birth control, to get prescriptions, if you’re experiencing symptoms, or simply to take the time to talk about whatever’s on your mind. The Pap test is just one part of preventive care—not the only reason to stop by.

If the Pap test shows abnormalities: usually no cause for concern

If a Pap test shows changes, it’s almost never an emergency—and certainly not a cancer diagnosis. If you come in for regular checkups, we always have plenty of time. Often, an HPV typing test is sufficient at first: if it’s negative, we’ll simply repeat the Pap test in a year. If necessary, we’ll take a closer look at the cervix using a special magnifying device (colposcopy) and take a small tissue sample. Often, these are minor changes anyway, about half of which resolve on their own within two years (Melnikow et al. 1998); in that case, we’ll simply check again after a few months.

If treatment is necessary

If a higher-grade abnormality is confirmed, the affected tissue is gently removed in a minor procedure (conization). We do not perform this procedure ourselves—we will refer you to a specialized hospital or center and continue to support you throughout the process. Modern techniques are gentle on the tissue, so subsequent pregnancies usually proceed completely normally.