Cancer screenings are an essential part of comprehensive health care. When it comes to women’s health, the screening for cervical cancer is one of the most familiar. However, the guidelines for cervical cancer screening have changed. No longer is a yearly Pap smear the recommendation for most women! Current research about the development and progression of cervical cancer has given way to updated guidelines.
One fact that has become clear as data has been gathered over time is nearly all cases of cervical cancer, in fact 99.7%, are caused by the human papilloma virus or HPV. There are several variants of HPV, and several have been identified as a high risk for producing cancer. Though many HPV infections may be cleared by the immune system, persistent infection with the virus can cause changes to cells of the cervix that eventually may lead to cancer. One important finding from the latest studies is that HPV causes cancerous changes slowly, often taking years. This is why the recommended time between screenings has been extended.
The purpose of any cancer screening is to identify early changes, increase the chance of cure and reduce the incidence of advanced stages of cancer. There is more than one way to screen for cervical cancer. The first ever screening test was the Papanicolaou smear, or Pap smear, developed in 1928 and instituted widely in America in the 1950s. After the start of widespread screening, cervical cancer rates declined considerably and have continued to fall over time. Today, cervical cancer is still a concern as the 18th leading cause of cancer-related death in the United States. The majority of these deaths are of women who were not properly screened.
The Pap smear is a test that uses cytology, a method that takes cells collected from the cervix and looks at them under a microscope to identify abnormalities. Another method for cervical cancer screening is simply to test for high risk HPV or hrHPV. Negative hrHPV testing indicates an extremely low chance of cervical cancer. Lastly, the option to co-test incorporates both cytology and hrHPV testing.
The most current cervical cancer screening guidelines recommend screening women beginning at 21 years old. Women ages 21-29 years should have a Pap smear every three years. Women ages 30-65 years should have a Pap smear every three years, hrHPV testing every five years or co-testing every five years. After age 65, it is reasonable to consider no longer screening for cervical cancer, but this should be a shared decision made between a woman and her health care provider.
Cervical cancer screening guidelines and testing methods have changed for the better! Be sure to get tested as recommended. It is important to note that these guidelines are for women at average risk of cervical cancer—those women who have never had an abnormal cervical cancer screening and have no significant family or personal history of certain cancers. Women who have had an abnormal screening in the past or have other risks factors will have a more frequent testing schedule. As always, be sure to discuss questions and concerns about cervical cancer screening with your health care provider.
References:
- JAMANetwork.com/journals/jama/fullarticle/2697704
- USPreventiveServicesTaskForce.org/uspstf/recommendation/cervical-cancer-screening#fullrecommendationstart
- ACOG.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines
- NCBI.nlm.nih.gov/pmc/articles/PMC4613936
Hailey Saunders. APRN, MSN, FNP-C, is a family nurse practitioner and Kansas City native who is passionate about evidence based health education.
As always, please consult your health care provider with any questions or concerns.