The American Cancer Society released new screening recommendations (14 March,2012) for the prevention and early detection of cervical cancer. Screenings are tests for women who have no symptoms of cervical cancer. Among the changes: the American Cancer Society no longer recommends that women get a Pap test every year.
Screening (March 21, 2013)
Recommendations for Cervical Cancer Screening
The latest guidelines, from 6 working groups and a recent symposium cosponsored by the American Cancer Society (ACS), the American Society for colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP), bring physicians and patients up to date.
The new updated guidelines include the following:
- Management of discordant co-tests, in which results of either Pap smear or HPV testing are positive, but not both, with integration of co-testing into follow-up. Colposcopy and/or HPV DNA typing may be indicated.
- Return to “routine” screening in women treated for cervical cancer.
- Extension of management guidelines for adolescents under 21 years of age to women under 25 years of age. Workup varies according to findings of atypical squamous cells of undetermined significance, or low-grade or high-grade squamous intraepithelial lesion, and may include colposcopy.
- Consideration of whether cervical intraepithelial neoplasia grade 1 (CIN1) on endocervical canal curettage (ECC) should be treated as positive ECC or CIN1.
- Management of women with unsatisfactory cytologic findings and specimens that are missing endocervical or transformation zone components. Colposcopy may be required for women with positive HPV results or with repeated unsatisfactory cytologic findings.
The ASCCP funded development of these guidelines.
As a rule, there are 2 types of tests used for cervical cancer screening.
- The Pap test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early, when it’s easier to treat. The Pap test (sometimes called a Pap smear or cervical cytology) is a way to examine cells collected from the cervix (the lower, narrow end of the uterus). The main purpose of the Pap test is to detect cancer or abnormal cells that may lead to cancer. It can also find noncancerous conditions, such as infection and inflammation. During the test, an instrument called a speculum is gently inserted into the vagina. This allows the cervix (the neck of the womb) to be clearly seen. A small spatula or a tiny brush is then inserted to collect cells from the cervix. These cells are smeared onto a glass slide and sent to a laboratory for analysis. The results are usually available within a week.
- The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don’t cause these problems. The HPV test may be used along with a Pap test, or to help doctors decide how to treat women who have an abnormal Pap test.
The American Cancer Society regularly reviews the science and updates screening recommendations when new evidence suggests that a change may be needed. The latest recommendations are:
- All women should begin cervical cancer screening at age 21.
- Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
- Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
- Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened.
- Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
- Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
- Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or exposure to the drug DES. They should talk with their doctor or nurse.
In short, the American Cancer Society no longer recommends that women get a Pap test every year, because it generally takes much longer than that, 10 to 20 years, for cervical cancer to develop and overly frequent screening could lead to procedures that are not needed.