If you're a woman - or a man - cancer screening guidelines have been all over the place of late. Here comes another refinement in the recommendations for cervical cancer screenings.
If you're a woman aged 21 to 65, you'll want to have a Pap smear every three years. If you're aged 30 to 65 and have had a human papillomavirus (HPV) test at the same time as a Pap, you can wait five years to have your next Pap.
The United States Preventive Services Task Force (USPSTF), along with The American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) have released these new guidelines in an effort to prevent or detect cervical cancer at its earliest stages.
"The new USPSTF guidelines for cervical cancer screening are consistent with the recommendation of the American College of Gynecology (ACOG) which also suggests that women with a negative HPV test and a negative Pap smear do not need to have testing every year," Iris Romero, MD, assistant professor of obstetrics/gynecology at the University of Chicago, told dailyRx in an email.
Some women don't need Pap smears
The new guidelines recommend that women under the age of 21 don't need to be screened regardless of their sexual history because there's no evidence the screenings reduce either cervical cancer incidence or deaths.
Similarly, women over the age of 65 who have had regular normal Pap smears and are not at high risk of the disease don't need to be screened.
Women who have had their cervix removed with a hysterectomy and do not have a history of either cervical cancer or precancerous lesions do not need to be screened. The Task Force writes, "In this population, there is high certainty that harms of screening outweigh the benefits."
What it all means
dailyRx asked Dr. Romero to explain all the recent changes. She said the key is to understand the nature of the disease itself. "First, cervical cancer is caused by the high risk strains of HPV, and if you do not have HPV you are very unlikely to get cervical cancer.
"Second, the progression from an abnormal Pap to pre-cancerous changes to actual cervical cancer usually takes several years. So, if we understand that high risk HPV must be present to get cervical cancer and that the disease progresses slowly over several years, then the guidelines start making more sense," Dr. Romero explained.
She continued, "If your Pap is normal and your HPV test is negative, several studies have shown that if you wait 5 years until your next Pap you will be fine."
You might want to know why not just have an annual Pap as you've always had. "The best argument against this old approach is that it does not prevent more deaths from cervical cancer compared to a Pap and HPV test every 3 years and costs more money."
USPSTF Task Force Chair, Virginia Moyer, MD, MPH, professor of pediatrics at Baylor Medical College, said in a news release announcing the new guidelines, "Screening every three years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies [biopsies of suspicious areas] and fewer false-positive [results that inaccurately suggest presence of cancer] tests."
The trail
It used to be that women got Pap smears every year. In 2009, that changed to every two years for women under the age of 30 and every three years for women over 30.
The Task Force released a draft recommendation in October 2011 which changed the ages screening should begin and the intervals.
Since the draft recommendation, new evidence regarding HPV testing along with Pap smears has come to light.
After reviewing the evidence, the USPSTF now recommends that women between the ages of 30 and 65 have HPV screening along with Pap smears. If both tests are normal, then the interval between Paps can be extended to five years.
HPV screening isn't recommended for women under the age of 30 because the infection is common in women in their 20s and often resolves itself.
The Center for Disease Control and Prevention (CDC) concurs with these recommendations.
All groups say that these guidelines should not mean that women skip their annual well woman check-ups.
Exceptions
Dr. Romero adds, "The guidelines do not apply to women who have a history of HIV, are immunocompromised or have a history of pre-cancerous changes of the cervix," she says.
"Also, if you are less than 30 years old, you should not space your Pap smears out to every 5 years.
The new guidelines also say physician should consider screening women over the age of 65 who have never had a Pap smear.
Summary of new USPSTF guidelines
Here's a quick overview of the latest recommendations:
- If you're 21-65, have a Pap smear every three years.
- Between ages 30-65, have a HPV test and Pap smear; if HPV test is negative and Pap smear is normal, wait 5 years for next screenings.
- If HPV test is negative and Pap smear is normal, wait 5 years for next screenings.
- If you're under the age of 21, don't have a Pap smear, regardless of your sexual history.
- If you're over the age of 65 and have had normal Paps, you don't need to be screened.*
- If you've had a hysterectomy, you don't need to be screened.*
- These guidelines don't apply to women with HIV, have an immune system disorder or have had precancerous lesions.
*This assumes no personal or family history of precancerous lesions or cervical cancer.
"The important part is that this is all an oversimplification," Dr. Romero says. "Screening at 1 year, 3 years or 5 years will depend on the individual patient’s age, risk factors, Pap smear history and patient preference."
Don't skip your annual well women exams
Even though you're not having an annual Pap smear, you still need to have an annual check-up.
"It is important to remember that when you visit the gynecologist s/he is doing much more than just screening for cervical cancer," Dr. Romero says.
"The annual exam includes an evaluation of breasts, uterus, ovaries and discussion of other gynecologic issues such as contraception.
"Therefore, you should still see the gynecologist every year even if you are not having a Pap smear," she urges.
Partner with your doctor
Because of all the confusion around this topic, Dr. Romero offers a simple solution:
"The best approach to cervical cancer screening is to discuss your individual situation with your gynecologist and develop a screening plan together."
