Women should be screened for cervical cancer every three to five years at most.

This recommendation came from the new guidelines issued today by The American College of Obstetricians and Gynecologists (The College), which also indicated that receiving the Pap test and the HPV (human papillomavirus) test at the same time is better than the Pap test alone. However, this is only suggested to females ages 30 and older and used once every five years.

These new guidelines, published in Obstetrics & Gynecology, are similar to the recommendations announced by the the American Society for Colposcopy and Cervical Pathology, American Cancer Society, and other medical associations earlier in the year.

David Chelmow, M.D., led the development of The College’s guidelines, explained:

“These recommendation changes are significant for physicians and patients alike. It will take some time and a lot of effort to re-educate everyone that the annual Pap is no longer the standard of care. It is critical, however, that women understand that their annual well-woman visit is still very important for many other aspects of their health care.”

The majority of American women who have cervical cancer either never received testing prior, or were not tested efficiently. However, over the last three decades, the cervical cancer rate has decreased by over 50% in the United States due to general Pap testing.

Although there is not one sole cause of this type of cancer, there are certain risk factors associated with the disease. The leading risk factor is cancer causing (oncogenic) strains of HPV, a common sexually transmitted infection.

The majority of females can destroy HPV infections on their own with a well-functioning immune system. However, cervical abnormalities will develop in a small percentage of women due to persistent HPV infection, eventually resulting in cancer.

Women ages 30 to 65 will see the biggest change in their screening guidelines. If they have negative results, they will be be co-tested with the Pap test (the traditional or liquid-based method) along with HPV test once every five years. If HPV screening is not accessible, a Pap test by itself is sufficient once every three years.

“We know that HPV infections are very common but most are transient and don’t progress to cervical cancer,” Dr. Chelmow explained. Most cervical cells that are precancerous can take years to develop into invasive cervical cancer, The College pointed out.

Dr. Chelmow continued:

“The evidence clearly shows that less frequent cervical cancer screening is warranted. With co-testing, screening every five years provides an excellent balance between achieving extremely low cancer rates while avoiding the potential harms of unnecessary interventions.”

According to the guidelines, women under the age of 21, even if they have had sexual intercourse, should not be tested for cervical cancer or HPV. This is because invasive cervical cancer is unusual in females younger than 21, even though HPV is common among sexually active teens.

It normally takes about 8 months for the immune system in young women to successfully eliminate HPV infection. Most cervical abnormalities that are associated with HPV infection typically clear up on their own, making no treatment necessary.

The College recommends that women ages 21 to 29 should no longer be tested for cervical cancer every two years, but once every three years.

Both the traditional Pap and the liquid-based method are adequate ways to receive screening. However, females under the age of 30 should receive screening with co-testing.

“The new guidelines emphasize that there is no role for tests that look for low-risk types of HPV,” Dr. Chelmow said. “When co-testing, we should be using only tests for high-risk, oncogenic types of HPV.”

Women older than 65 should no longer receive screening for cervical cancer if:
  • they have no history of cervical cancer
  • no history of cervical intraepithelial neoplasia (CIN) 2 or CIN 3
  • no history of adenocarcinoma in situ
  • had three consecutive negative Pap test results
  • had two consecutive negative co-test results within the past 10 years, with the most recent test within the previous five years
Women, no matter what age, should discontinue routine screening if they have no history of CIN 2 or CIN 3 and who have had a hysterectomy with removal of the cervix (total hysterectomy).

HPV-vaccinated women should follow the same guidelines as those who are unvaccinated.

The recommendations are not meant for women who are:
  • immunocompromised
  • HIV-positive
  • were exposed to diethylstilbestrol (DES) in utero
These females may need more to be tested more often – as frequently as recommended by their physician.

Written by Sarah Glynn