From the Guidelines
Cervical cancer screening is recommended for all women starting at age 21, with different approaches based on age, as outlined in the guidelines from the American Cancer Society and the US Preventive Services Task Force 1.
Screening Recommendations
- Women aged 21-29 should have a Pap test every 3 years, as HPV testing is not recommended for this age group 1.
- From ages 30-65, the preferred approach is a Pap test plus HPV testing (co-testing) every 5 years, though a Pap test alone every 3 years is also acceptable 1.
- Screening can stop after age 65 if there's a history of adequate negative screening results and no high-risk factors 1.
Importance of Screening
The screening involves collecting cells from the cervix during a pelvic examination, which are then examined for abnormalities. HPV testing checks for the presence of high-risk human papillomavirus types that can cause cervical cancer. This screening is crucial because cervical cancer develops slowly, and detecting precancerous changes early allows for effective treatment before cancer develops 1.
Special Considerations
Women who have had a hysterectomy with removal of the cervix and no history of cervical cancer generally don't need screening 1. Those with risk factors like HIV infection, immunosuppression, or previous treatment for cervical precancer may need more frequent screening as recommended by their healthcare provider 1.
Key Points
- The American Cancer Society estimates that 12,360 women will be diagnosed with invasive cervical cancer, and 4030 women will die from the disease in 2013 1.
- Cervical cancer incidence and mortality rates have declined since the introduction of the Papani colaou (Pap) test in the mid-20th century, and rates continue to decline to this day 1.
From the Research
Cervical Cancer Screening Methods
- Cervical cancer screening can be performed using various methods, including the ThinPrep cytology test (TCT) and cervical biopsy 2
- Human papillomavirus (HPV) testing can also be used to identify women at risk for posttreatment cervical intraepithelial neoplasia grade 2 or 3 disease after loop electrosurgical excision procedure (LEEP) 3
Risk Factors for Cervical Cancer
- Almost all cases of cervical cancer can be attributed to human papillomavirus (HPV) infection 2
- Women with long-term persistent, high-risk HPV infection and negative pathology results of cervical biopsy after LEEP are at risk of cervical cancer 2
- HPV16 positivity is associated with a higher risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 disease compared to other carcinogenic HPV types 3
Colposcopy and Biopsy
- Colposcopy is a diagnostic procedure to evaluate for vaginal, vulvar, and cervical dysplasia, and its practice has evolved to incorporate patient risk factors for high-grade cervical intraepithelial neoplasia (CIN) and cancer 4
- Cervical biopsy under colposcopy may not always yield accurate results, especially in patients with cervical scars after LEEP 2
- Hysteroscopic resection of cervical canal tissue may be recommended as a supplement to cervical biopsy to define the lesion site and yield a pathologic diagnosis 2
Surveillance and Follow-up
- Patients with abnormal cervical cancer screening history require surveillance, which differs from routine screening for patients with normal prior screening results 4
- Long-term surveillance is recommended for patients with CIN 2 or worse 4
- Primary care clinicians should develop clinic-based systems to ensure appropriate follow-up of abnormal cytology, positive high-risk HPV testing, diagnosed CIN, and cervical cancer 4