Since the introduction of cervical screening with Pap tests in the 1950s, the death rate from cervical cancer, once one of the leading causes of cancer death in women, has plummeted. Nevertheless, every year several thousand women in the United States still die from cervical cancer; the vast majority of them never had a Pap test (aka Pap smear) nor were they vaccinated against human papillomavirus (HPV), the sexually transmitted virus that causes cervical cancer. Cervical cancer develops slowly, over many years, through well-defined stages during which treatment can be curative. These stages can be identified on a Pap test and are graded according to how dangerous they are.
Regular Pap screening can detect small problems before they become big problems, and thereby save lives. In some women, screening for HPV infection can further improve the accuracy of screening. The new screening guidelines, released this year by the United States Preventive Services Task Force (USPSTF), a government-authorized group of specialists in preventive and primary care, take all of these factors into account.
USPSTF Guidelines for Cervical Cancer Screening
The new guidelines for healthy women who have not had a high-grade abnormal Pap test in the past are as follows:
- Women 21 to 29 should get a Pap test every three years
- Women 30 to 65 can continue to get a Pap test every three years or choose to obtain a Pap test plus HPV testing every 5 years
- Women younger than 21 shouldn’t be screened
- Women over 65 who have had previous adequate screening and don’t have a recent abnormal pap history don’t require further screening
- Women who have had a hysterectomy that included removal of the cervix and have no cancer history or precancerous abnormalities on previous screening shouldn’t get further testing
How Are the Guidelines Determined?
You may wonder how the USPSTF arrived at these particular guidelines for cervical cancer screening, and why it chose these particular screening intervals. If a little screening is good, after all, why not screen more often–say every year–and do an HPV test as well? Here’s the rationale.
First, because cervical cancer grows so slowly, more frequent screening doesn’t confer any benefit. The previous one-year screening interval was picked arbitrarily; the new recommended intervals are based on evidence!
Second, screening can actually be harmful. False positive tests can lead to unnecessary additional invasive testing, such as colposcopy and cervical biopsy, that can cause pain, infection, and bleeding, as well as marked psychological trauma, such as anxiety and genuine fear about health.
Third, although HPV screening increases the ability to detect worrisome precancerous cervical lesions and cancer, in many cases HPV infection is transient and the cellular changes quickly return to normal. This means that the body has an amazing ability to heal itself. Studies show that most women can clear HPV causing cellular changes within two years. Thus, HPV testing alone could lead to many false positive results with all the attendant potential complications discussed above.
If You Have Abnormal Results
If, after following these guidelines, the results of your Pap test or (when appropriate) HPV testing comes back as anything other than normal, your health care provider will guide you through the next stages of your evaluation. However, rest assured that because you’ve followed the recommended screening protocol, your risk of having aggressive cervical cancer is very, very low and that any persistent cellular changes can be successfully treated for a complete cure. If you haven’t already done so, talk to your health care provider now about getting into a proper, recommended sequence of cervical cancer screening.
Beyond Screening: What You Can Do
Don’t forget to make sure that you or your children have received three doses of one of the HPV vaccines. HPV vaccination is now recommended for girls between the ages of 11 and 12 (although vaccination can start as early as 9); for young women 13 to 26 who never received the vaccine; and for young men aged 13 to 26 (HPV can cause problems in men, too). The vast majority of boys and men who have HPV will never develop symptoms or health problems as a result of the virus, but vaccination is important to help reduce the spread of HPV.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.
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