New Cervical Cancer Screening Guidance
- Cervical cancer screening should begin at age 25 with a primary HPV test (a more “sensitive” test than a Pap test) and continue every 5 years.
- Those over age 65 who have had regular screenings (with no serious diagnosis within the past 25 years) should stop cervical cancer screening.
- If primary HPV tests are not available, screenings can be done as a co-test (a combined HPV test and Pap test) every five years or a Pap test every three years.
The news follows a recent HPV vaccination guideline update, which set 26 as the top age people should be when getting the vaccine.Read More
The guidelines apply equally to those who have had the HPV vaccine, known as Gardasil, and include transgender persons who have a cervix, along with young adult women. There are three main differences when compared with the previous recommendations, which were set forth in 2012.
Here’s What’s New, According to the ACS
- Cervical cancer screening should begin at age 25 with a primary HPV test and continue every 5 years.
- Those over age 65 who have had regular screenings in the past 10 years (with normal results and no history of CIN2 or more serious diagnosis within the past 25 years) should stop cervical cancer screening.
- If primary HPV tests are not available, the ACS recommends a co-test (a combined HPV test and Pap test) every five years or a Pap test every three years.
What Does Co-Testing Mean?
The primary HPV test screens for human papillomavirus and, doctors say, it’s more sensitive than a Pap test. The HPV test looks for DNA or RNA from certain high-risk strains of HPV– those that cause cervical cancer — in samples of cells taken from the cervix.
Co-testing refers to performing both a Pap and HPV test at the same time.
Both tests take place during routine visits to the gynecologist through a pelvic exam. The tests involve taking cell samples from the cervix. While not particularly painful, the tests do involve an internal pinching feeling. The same set of sample cells may be used to conduct both tests.
If you’re not sure which test — or tests — you’re getting, ask your gynecologist to explain this during the exam.
“Many times, women have a speculum exam and they assume they’ve had a cervical screening test,” says Dr. Kimberly Levinson, Director of Johns Hopkins Gynecologic Oncology at Greater Baltimore Medical Center.
“It’s important to ask your doctor, ‘Was a screening exam performed?'” she advises. “I can’t tell you how many times I’ve asked someone and they don’t know if they’ve actually had a cervical screening.”
The vast majority of humans in the U.S. will eventually get infected with human papillomavirus,” says Dr. Allen Ho, a head and neck surgeon at Cedars-Sinai Medical Center.
A Testing Transition
The new ACS guidelines represent a shift toward the primary HPV test as the “preferred method of testing” as the United States is in a “transition period” away from the “former mainstay” of Pap smears. “Primary HPV testing is more sensitive — it’s a good test,” says Dr. Levinson, “but implementation has been challenging across the country.” Don’t be surprised if your health care provider does not offer it yet. In that case, go with a Pap test every three years, or co-testing.
The primary HPV test is more accurate than the Pap test – according to several new studies – and can be done less often, the ACS says. The FDA has approved two primary HPV tests in recent years, which represent a step forward in doctors’ ability to screen for cervical cancer.
Before a Screening Test: What To Know
Before you see a doctor for a checkup that will include a Pap or HPV test, there are a few things you can do to ensure accurate results, according to the CDC.
First, don’t schedule a test for a time when you are having your period. Fo the two days prior to your appointment, do not douche or rinse the vagina with fluid. Also, do not use a tampon, have sex, or use a birth-control cream, foam, or jelly — and avoid using any other medicine or topical cream in your vagina.
While screening is essential for everyone with a cervix, Dr. Levinson emphasizes the importance of getting the HPV vaccination, especially in young adults who did not get the vaccine as pre-teens. “Every woman who is eligible for that should get it,” she notes. “That is a number-one, primary prevention.”
Parents who were hesitant about the HPV vaccine when it was introduced in 2006 should now urge their young-adult children — both men and women — to get vaccinated.
But even those who’ve been vaccinated should continue with regular screenings. “This is not a cancer that produces symptoms early on,” she explains. “So it is absolutely critical that we have women being screened so that we can prevent this disease.”
HPV and Cervical Cancer
About 13,170 new cases of cervical cancer will be diagnosed this year, making up about 0.7% of cancer diagnoses, according to the National Cancer Institute. The disease has a 65.8% survival rate after five years. Along with the new guidelines, the ACS says there is a “critical need for counseling and education related to HPV infection.”
Nearly all sexually active people will be infected with Human papillomavirus (HPV) infection almost immediately after they become sexually active, according to the National Cancer Institute. “HPV is prevalent in that age group,” says Dr. Levinson, speaking of people in their early twenties, adding that “most will go on to clear it.”
What’s Staying the Same
1. The time between screenings remains at every 5 years for HPV testing and every 3 years for Pap tests
2. For those who test positive for HPV, the 2019 follow-up guidelines set out by the American Society for Colposcopy and Cervical Pathology still stand
3. Age of screening cessation remains at 65
4. Your HPV vaccination status doesn’t change the need for screening — even if you’ve had the Gardasil vaccine, you still need to screen for HPV
Special Cases: Is This You?
People who have had a total hysterectomy (removal of the uterus and cervix) should stop HPV and Pap screenings unless the hysterectomy was done as a treatment for cervical cancer or serious pre-cancer. If the hysterectomy did not remove the cervix, screening for cervical cancer should continue according to the guidelines above.
The ACS also noted that some people mistakenly believe that they can stop cervical cancer screening once they have stopped having children. This is not true. Even after childbearing years, anyone with a cervix should continue to follow American Cancer Society guidelines.
Women with a health history that includes HIV infection, organ transplant, DES exposure, and other complicating health factors may need to be screened more often. Discuss this with a health care provider who is familiar with your full medical history.