A Pap smear (ujian pap smear) is a quick test that checks cells from the cervix for changes that could become cervical cancer, so they can be treated early. In Malaysia, Pap smears have been offered since 1969 and free at government health facilities since 1998, and national cancer registry data show cervical cancer rates falling from 7.6 per 100,000 women in 2007–2011 to 6.0 in 2017–2021. The Ministry of Health's 2019 guideline adds HPV testing, which checks for the virus that causes most cervical cancers: sexually active women aged 30 to 49 should have an HPV test (which can be self-collected) every 5 years if negative, while women aged 21 to 29 and 50 to 65 are advised to have a Pap smear. This guide explains the difference between a Pap smear and an HPV test, who needs which, what happens during the test, what your results mean, and which symptoms should not wait for screening.
What is a Pap smear?
The cervix is the opening of the womb at the top of the vagina. A Pap smear (also called cervical screening or a smear test) takes a small sample of cells from the cervix so a laboratory can look for abnormal changes. These changes are not cancer, but some could become cancer over many years if they are not treated.
Cervical cancer develops from long-lasting infection with high-risk types of human papillomavirus (HPV). Malaysia's Ministry of Health (MOH) notes that HPV is the most common viral infection of the reproductive tract, that most sexually active people will be infected at some point, and that most infections clear up without treatment. Cervical cancer is a rare result of an infection that does not clear.
Pap smear untuk apa? Its purpose is prevention: finding and treating cell changes before cancer develops. It is meant for women without symptoms. If you have symptoms, see a doctor instead of waiting for your next screening. Breast cancer has its own screening; see our guide to kanser payudara and mammograms.
Pap smear vs HPV test
Why HPV testing? A follow-up of four large European randomised trials with more than 176,000 women found that HPV-based screening gave 60% to 70% greater protection against invasive cervical cancer than cell-based (Pap) screening, and supported starting HPV screening at age 30 with intervals of at least 5 years. This evidence underpins the move to HPV testing in many countries, including Malaysia.
Who should be screened, and how often?
Malaysia's national Pap Smear Screening Programme, introduced in 1998, covers eligible women aged 20 to 65: yearly for the first 2 years, and every 3 years after that if results are normal. The MOH's 2019 Guidelines for Primary HPV Testing in Cervical Cancer Screening in Malaysia set out the newer approach:
- Sexually active women aged 30 to 49: screen with an HPV test, which can be self-collected or taken by a health worker.
- Women aged 21 to 29 and 50 to 65: Pap smear screening is advised.
- If your HPV test is negative: your next screening should be in 5 years.
Pap smears are available free at government health facilities. Ask at your klinik kesihatan or your own doctor about which test suits your age and when you are due.
HPV vaccination also protects against cervical cancer. Malaysia's national school-based HPV immunisation programme began in 2010 for girls aged 13 (Form 1). Keep attending screening when invited, as advised by your doctor.
What happens during the test
Pap smear or clinician-taken HPV test. According to the NHS:
- you undress from the waist down behind a screen and are given a sheet to cover yourself;
- you lie back with your knees bent and apart, or on your side if that is easier;
- the nurse or doctor gently inserts a smooth, tube-shaped tool (speculum) to see your cervix, then uses a soft brush to take a small sample of cells;
- the test itself takes less than 5 minutes, and the whole appointment about 10 minutes.
HPV self-sampling. With self-sampling, you use a swab to collect a sample from your vagina yourself, usually in private, following the instructions in the kit. The MOH guideline allows samples to be taken either by the woman herself or by a health worker.
Tips if you feel nervous (from the NHS):
- wear a skirt or long top you can keep on;
- bring someone with you for support;
- ask for a smaller speculum, or ask whether you can insert it yourself;
- ask to lie in a different position;
- remember you can ask to stop at any time.
The test does not usually hurt, though some women find it uncomfortable. Light bleeding or spotting for a few hours afterwards can happen.
What your results mean
Under Malaysia's 2019 HPV screening guideline:
A positive HPV result is not a cancer diagnosis. The NHS also points out that a positive result does not mean your partner has had sex with someone else, and that HPV can be present even if you have not had a new partner for many years. If you are referred for a colposcopy, try not to worry; it is a closer check of the cervix, and the NHS notes that any cell changes will not get worse while you wait for your appointment.
Symptoms that should not wait
Screening is for women without symptoms. According to the NHS, see a doctor if you have possible symptoms of cervical cancer, even if your last screening was normal:
- vaginal bleeding that is unusual for you, including during or after sex, between periods, or after the menopause, or periods heavier than usual;
- changes to your vaginal discharge (see our guide to keputihan);
- pain during sex;
- pain in your lower back, pelvis or lower tummy.
The NHS notes these symptoms are very common and can be caused by many different conditions, such as fibroids or endometriosis, but they should still be checked. Our guides to irregular periods and period pain explain other common causes.
Frequently asked questions (FAQ)
What is a Pap smear for (pap smear untuk apa)?
A Pap smear checks cells from your cervix (the opening of the womb) for changes that could turn into cervical cancer if left untreated. It is a screening test to help prevent cancer, not a test for symptoms. An HPV test checks for the human papillomavirus that causes most cervical cancers.
Who should get a Pap smear in Malaysia?
Malaysia's Ministry of Health has offered Pap smear screening to women aged 20 to 65, yearly for the first 2 years and then every 3 years if results are normal. Its 2019 guideline adds HPV testing: sexually active women aged 30 to 49 should be screened with an HPV test, while women aged 21 to 29 and 50 to 65 are advised to have a Pap smear.
How often should I have an HPV test?
According to Malaysia's 2019 HPV screening guideline, if your HPV test is negative, your next screening should be in 5 years. If it is positive, you will be asked to have further tests, such as a cytology test or a colposcopy.
Does a Pap smear hurt?
It does not usually hurt, but some women find it uncomfortable. The test itself takes less than 5 minutes. You can ask for a smaller speculum, ask to change position, or ask to stop at any time. Light spotting for a few hours afterwards can happen.
What does a positive HPV result mean?
It means a high-risk type of HPV was found, not that you have cancer. HPV is very common and usually clears on its own. Depending on the type, you may be referred straight for a colposcopy (HPV 16 or 18) or have a cytology test first. A positive result does not mean your partner has been unfaithful.
Can I do an HPV test myself?
Yes. Malaysia's Ministry of Health uses HPV self-sampling, where you collect a vaginal sample yourself with a swab, as part of its cervical cancer screening. Ask at your klinik kesihatan or doctor about how to get a kit and where to return it.
What symptoms should not wait for screening?
See a doctor, even if your screening is up to date, if you have unusual vaginal bleeding (during or after sex, between periods or after menopause), heavier periods than usual, changes to your vaginal discharge, pain during sex, or pain in your lower back, pelvis or lower tummy.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Guidelines for Primary HPV Testing in Cervical Cancer Screening in Malaysia (2019) — Family Health Development Division, Ministry of Health Malaysia
- Publication of the Summary of the Malaysia National Cancer Registry Report 2017-2021 — Ministry of Health Malaysia statement via Bernama
- What happens at your cervical screening appointment — NHS
- Your cervical screening results — NHS
- Symptoms of cervical cancer — NHS
- Ronco G, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2014;383(9916):524-532.
