New national recommendations for cervical cancer screening of women ages 21-to-65 years of age offer three testing options, beginning at age 30, to be selected in consultation with a woman’s primary care provider. Regardless of which option a woman chooses, what is most important is that she be regularly screened, says Carol Mangione, MD, MSPH, a UCLA Health internal medicine physician who headed the panel of experts from the U.S. Preventive Services Task Force, which issued the guidelines.
“Screening for cervical cancer saves lives and identifies the condition early, when it is treatable,” says Dr. Mangione, chief of the Division of General Internal Medicine and Health Services Research. “There are several effective screening strategies available, so women should talk to their doctors about which one is right for them.”
The recommendations call for primary care clinicians to screen women ages 21-to-29 every three years with cervical cytology, more commonly known as the Pap test. For women 30-to-65, there now are three recommended options: a Pap test alone every three years, screening every five years for high-risk human papillomavirus (HPV), or Pap and HPV screening together every five years.
Women older than 65 who have been adequately screened with repeated normal results during the prior 10 years need no further screening, the guidelines state.
The recommendations apply to women with a cervix and no signs or symptoms of cervical cancer. They are not for women at high risk for the disease, such as those who have previously been diagnosed with a high-grade precancerous cervical lesion.
Cervical cancer rates and deaths have declined significantly in the U.S. in the last several decades as a result of the increased prevalence of women getting regular screening. But Dr. Mangione notes that there continues to be a significant disparity in cervical cancer screening, with low-income and minority women the least likely to get the recommended tests. “We know that many women who present with cervical cancer and most women who die from cervical cancer have not been adequately screened, so it’s clear that we are not reaching everyone,” she says.
Home-test kits for high-risk HPV currently are in development, which could increase the number of women who are appropriately screened, particularly if home testing reaches those who lack access because of their health insurance status or for other reasons, Dr. Mangione says.
“The bottom line is that very few cancer screening tests are known to decrease mortality, and we have that for cervical cancer,” she adds. “Regardless of which option women choose, the important thing is that they get screened.”
21 – 29 years old
Screening every three years with cervical cytology (Pap test)
30 – 65 years old
1. A Pap test alone every three years
2. Screening every five years for high-risk human papillomavirus (HPV)
3. Screening using both tests together every five years
65 and older
who have been adequately screened with repeated normal results during the prior 10 years need no further screening