Both the cervical smear (Pap test) and the HPV test are used to screen for cervical cancer, but they do not look for the same thing.
Put simply:
Pap smear → looks for cervical cells that have changed abnormally.
HPV test → looks for the high-risk HPV types that can cause those changes.
One test looks at the “effect on the cells”, while the other looks for the “risk factor that causes the cell changes”.
How do the Pap smear and the HPV test differ?
Both are screening tests, not tests that confirm cancer.
If a result is abnormal, your doctor will decide on the next step based on the type of abnormality and each person's own risk.
How does the Pap smear work?
During the examination, a healthcare worker uses a small instrument to collect cells from the cervix.
The sample is then examined in the laboratory to see whether the cells are:
- Normal
- Mildly changed
- Pre-cancerous lesions
- Or showing signs that need further checking
The Pap smear has been used for decades to help pick up, at an early stage, changes that could progress to cervical cancer.
What does the HPV test check for?
The HPV test focuses on the high-risk HPV types.
HPV is behind almost all cases of cervical cancer. But this does not mean that everyone who catches HPV will develop cancer.
Problems mostly arise when a high-risk HPV type persists for many years, which can then cause changes in the cervical cells.
Some tests can also identify HPV 16 and HPV 18 separately – two particularly important high-risk types.
So should women choose the Pap smear or the HPV test?
There is no single answer that fits everyone.
If you are eligible for primary HPV testing
Modern guidelines increasingly favour primary HPV testing – the HPV test as the first-line test in the appropriate age groups, because the HPV test can detect risk before clear changes appear in the cells.
According to the updated guidelines of the American Cancer Society, for people with a cervix who are at average risk and aged 25 to at least 65, primary HPV testing on a cervical sample collected by a healthcare worker is the preferred option and can be done every 5 years.
However, this is an ACS guideline for the United States, and it should not be applied mechanically to all women in every country.
If primary HPV testing is not suitable or not available
The Pap smear remains an accepted screening method.
According to the ACS, a Pap smear on its own can be carried out at appropriate intervals when HPV testing is not available.
Can you have both the Pap and the HPV test?
Yes.
When both are done at the same time, this approach is called:
HPV/Pap co-test.
A co-test tells you, at the same time:
Is high-risk HPV present?
and
Have the cervical cells already changed?
However, according to the ACS, in people at average risk a co-test does not necessarily offer a significantly greater benefit than primary HPV testing alone when the HPV test is suitable and available.
How to read the 4 common situations
HPV negative + normal Pap
This is usually a low-risk result.
You carry on with screening according to the schedule advised by your doctor or health facility.
HPV positive + normal Pap
High-risk HPV is present but no cell changes have been found on the Pap.
Depending on the HPV type and your history, your doctor may ask for a repeat test after a period of time, or for further assessment.
HPV negative + abnormal Pap
No high-risk HPV is found, but the cervical cells show changes.
Your doctor will look at the degree of abnormality to decide whether follow-up or further checking is needed.
HPV positive + abnormal Pap
This situation needs a more thorough assessment.
Depending on the results, your doctor may order a colposcopy or a biopsy to establish the nature of the lesion.
Importantly: two positive results still do not mean cancer.
If you have already had the HPV vaccine, do you still need screening?
Yes.
The HPV vaccine helps prevent the major cancer-causing HPV types, but it does not give complete protection against every high-risk HPV type.
For that reason, people who have had the HPV vaccine should still have cervical screening in line with the guidance that suits their age and risk.
Who needs a separate screening schedule?
The guidance for people at average risk does not fully apply if you:
- Have had an abnormal Pap smear or HPV result
- Have had a pre-cancerous cervical lesion
- Have been treated for a cervical lesion
- Have a weakened immune system
- Are living with HIV
- Have had surgery to remove the cervix or the uterus, in certain cases
People in these groups should speak directly with a doctor to arrange a suitable follow-up schedule.
Do not choose a test just because “one package includes more”
The Pap smear, the HPV test and the co-test are not three levels running from low to high.
Each method answers a different question.
What matters more is:
How old are you?
Was your previous screening abnormal?
Are you in the average-risk or the high-risk group?
Choosing the right test matters more than choosing many tests.
Book women's health screening on Halza
Through Halza, you can look up and book gynaecological consultations, HPV tests and cervical cancer screening at partner hospitals and clinics.
Keeping your results across several visits also makes it easier to follow your Pap smear and HPV history and your next check-ups.
The Pap smear looks for changes in the cells. The HPV test looks for the high-risk virus. Understanding the difference properly will help you choose a screening method that suits you better.
The information in this article is for reference only and does not replace a doctor's advice, diagnosis or instructions. The starting age, the type of test and the screening interval may differ depending on the guidelines, your history and your individual risk.
Frequently asked questions
Is the Pap smear an HPV test?
No.
Samples for the two tests can be taken during the same gynaecological examination, but they have different aims.
The Pap smear examines cells taken from the cervix to look for pre-cancerous or abnormal cells.
The HPV test looks for the high-risk HPV types linked to cervical cancer.
Does a positive HPV result mean you have cancer?
No.
HPV is very common, and in many cases an HPV infection is brought under control by the immune system on its own.
What doctors are more concerned about is whether high-risk HPV persists over a long period and whether abnormal changes have already appeared in the cervical cells.
A positive HPV result therefore does not mean cervical cancer.
Does an abnormal Pap smear mean cancer?
Again, not necessarily.
An abnormal Pap can show cell changes of varying degrees. Some mild changes can return to normal on their own, while some cases need an HPV test, a colposcopy or a biopsy for further assessment.
References
- American Cancer Society – Cervical Cancer Screening Guidelines
- National Cancer Institute – Cervical Cancer Screening
- CDC – Screening for Cervical Cancer
- American Cancer Society – Screening Tests for Cervical Cancer
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