Can a Pap Smear Test Miss Cervical Cancer?

Can a Pap smear miss cervical cancer? How accurate is it really? Should you combine it with other tests? These aren't just anxious thoughts, they're questions that you might be asking.

Medical tests aren't pass/fail exams where 'normal' means perfect and 'abnormal' means disaster. They're screening tools with strengths, limitations, and margins of error. The Pap smear is no exception. Knowing these limitations isn't about creating fear – it's about giving you the knowledge to protect yourself more effectively.

What is cervical cancer?

Cervical cancer develops in the cells that line your cervix, which is the lower, narrow end of your uterus (womb).

Unlike other cancers that appear suddenly, cervical cancer grows slowly over several years. It usually begins with precancerous changes that can progress to cancer if left untreated.

One of the primary causes of cervical cancer is persistent infection with high-risk human papillomavirus (HPV) types. You may also be at higher risk if you smoke, have a weakened immune system, or have had multiple sexual partners.

However, regular cervical screening can detect these changes early, often before cancer develops.

What is a Pap smear?

A Pap smear test is a cervical cancer screening test that your doctor uses to detect abnormal cervical cells in your cervix before they become cancerous.

Although it does not directly diagnose cancer, it helps identify cellular changes that require further testing or monitoring.

Can a Pap smear test miss cervical cancer?

Yes, a Pap smear can occasionally miss cervical cancer. While it is an important and effective screening tool, it is not perfect on its own.

Studies have shown that Pap tests by themselves may detect only about two-thirds of cervical cancer cases. This happens for several reasons, such as:

• The sample collected may not contain enough abnormal cells:

  • The test only examines cells from a small area of your cervix, so if abnormal cells exist deeper in the tissue, a Pap smear may not detect them.

• Subtle changes can be misinterpreted:

  • This situation is rare but possible. Early cellular changes can be hard to interpret correctly, especially when they're subtle.

  • If your doctor has any concerns about a result, they can request a second pathologist review or recommend follow-up testing for confirmation for you.

• Cancer develops rapidly between screenings:

  • It is uncommon but can occasionally happen between screenings. This is why it's so crucial to pay attention to symptoms, even if your Pap test is normal.

Because of this, many doctors now recommend co-testing – a Pap smear combined with an HPV test. This combination has been shown to detect significantly more cases than relying on the Pap smear alone, giving you clearer and more reliable results.

Concerned about your Pap smear results? Schedule an appointment at Thomson Medical. Our specialist will help you understand your results, guide you through the next steps, and create a clear care plan tailored to your needs.

Factors that can lead to missed cervical cancer

There are several factors that can contribute to false results and knowing this can help you prepare better for the test as well as ensure the most reliable outcomes.

• Improper sample collection:

  • It happens when the cells are not collected correctly or from the right location. That’s why it’s important to see an experienced healthcare provider for your Pap smear.

• Menstrual blood or vaginal infections:

  • They can obscure the cells and make it harder for your doctor to evaluate properly. In this case, your doctor might recommend rescheduling if you have your period or an active infection.

• Use of vaginal creams or douches before the test:

  • These can wash away or cover up abnormal cells. If you are unsure what to avoid, your doctor will give you specific instructions before the test.

It’s always better to double-check with your doctor beforehand. They will help you address your concerns and make sure you feel confident about your screening.

What are the next steps if a Pap test misses cervical cancer?

If you continue to experience unusual changes, even when your Pap smear is normal, your gynae cancer specialists may recommend follow-up testing to investigate what's causing them and ensure nothing is overlooked.

Here’s what might come next:

A repeated Pap smear

Your doctor might suggest that you do a repeated Pap smear in a few months to see if the abnormality persists or resolves on its own.

If the repeated Pap smear results remain abnormal, you may be advised to undergo further diagnostic testing.

HPV testing

This test detects high-risk HPV strains that are most likely to cause cervical cancer. HPV testing is useful because it can identify these viruses even before they cause visible cellular changes.

Co-testing, which is when you have both a Pap smear and HPV testing at the same time, is becoming more common, especially for women over 30,  because it provides a clearer picture of your cervical health.

Colposcopy

If your Pap test results suggest you need more evaluation, your doctor might recommend a colposcopy. This is an in-depth examination of the cervix using a special magnifying device.

During the process, your doctor will look for abnormal areas and may apply a mild solution to highlight suspicious cells. The procedure is quite similar to a Pap smear but may take longer, usually 10-20 minutes.

Biopsy

If your doctor detects abnormal tissues during colposcopy, they will take a small sample of the tissues and send it to the lab for closer examination. This is called a biopsy, and it’s the only method to confirm a cancer diagnosis. You will usually get the result after 1-2 weeks.

You may experience a quick sharp pinch or cramping pain, similar to strong menstrual cramps, during the process. However, they last only a few seconds. Your doctor will provide ways to help you manage the pain if you have concerns about discomfort.

There is no perfect screening test, but regular screening, especially combined with HPV vaccinations, can help reduce your cancer risk.

It’s also important to remember that you are not expected to go through these cervical screening tests alone. Your doctor will explain why you need the specific tests, what to expect at each step, and plan the schedule of check-ups that is for you.

If you have concerns about cervical health, schedule an appointment at Thomson Medical. Our gynaecologic oncologists can guide you through the right tests for early detection and provide personalised care every step of the way.

FAQ

When should a woman get a Pap smear?

What is the difference between a Pap smear and an HPV test?

Are there risks to getting a Pap smear?

What causes “not enough cells” in a Pap smear?

If my Pap smear is normal, does that mean I don't have cervical cancer?

What are the signs of cervical cancer that shouldn't be ignored?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situation, please consult a specialist at Thomson Medical.Schedule an appointment with Thomson Medical today.