According to new guidelines from the United States Preventative Services Task Force (USPSTF), published early online in Annals of Internal Medicine, women aged between 21 and 65 should have a Pap smear every 3 years. If women aged 30 to 65 undergo the humanpapillomavirus (HPV) test at the same time as the Pap, they can safely extend the screening interval to once every 5 years.
Based on sufficient evidence, the USPSTF advises that women under the age of 21 should not undergo screening for cervical cancer, regardless of sexual history, as it does not lower the incidence of cervical cancer and mortality. In addition, women over the age of 65 also do not require screening if they have had adequate prior screening and are not otherwise at high risk.
Task Force Chair, Virginia Moyer, M.D. MPH, Professor of Pediatrics, Baylor Medical College, explained:
“This is good news for women because evidence shows that an annual Pap smear is not necessary to prevent deaths from cervical cancer. Screening every three years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests.”
Ever since a draft recommendation was released in October 2011, new evidence emerged regarding the role of HPV testing in cervical cancer screening.
After reviewing the evidence, the USPSTF advises that women aged 30 to 65 undergo HPV screening and the Pap at the same time. By combining these tests, women can prolong their screening interval to five years. The USPSTF does not advise that women under the age of 30 undergo HPV screening, as the infection is more common in younger women and usually clears up on its own.
The Center for Disease Control and Prevention reports that women aged 30+ who receive a normal Pap result are at significantly low risk of developing cervical cancer in the next few years. Even though this information backs the wisdom of prolonged screening intervals, women should never miss regular check-ups.
The new guidelines reveal that women do not need to be screened if they have undergone a hysterectomy with removal of the cervix and who do not have a history of cervical cancer or a high-grade precancerous lesion, as there is high certainty that the harms of screening outweigh the benefits in this population.
In addition, women aged 65+ can stop undergoing screening if they have received 3 consecutive negative Pap smears or 2 negative co-tests within one decade prior to ending screening, with the last test performed within 5 years.
Regular screening should continue at least 2 decades following spontaneous regression or appropriate management of high-grade precancerous lesion, no matter what age the patient is. Cervical cancer screening should be taken into consideration by physicians in women aged 65+ who have never been screened.
Written by Grace Rattue