Cervical Cancer Screening

The Pap test is used to identify women that might be at risk of cervical cancer (cervical cancer screening). The test has saved many lives because this type of cancer can be treated effectively if found early. A virus called the human papillomavirus (HPV) causes most cervical cancers. Knowing this, healthcare providers often use an HPV test together with a Pap test. This approach is called “co-testing” and is used to screen for cervical cancer mostly in women 30 to 65 years of age.Why Screening for Cervical Cancer is ImportantCancer of the cervix, the lowest part of the uterus (womb), used to be the leading cause of cancer death in women in the United States. However, in the 1940s healthcare providers started using the Pap test. Since screening using the Pap test began, more at-risk women are found early on and fewer get cervical cancer.^1,2 But not all women get the Pap test regularly, and about half of all cervical cancers happen in women who have never been tested.³Screening for Cervical CancerHealthcare providers use screening to detect cervical cancer in women who have no signs of it. It can take many years for cells infected with HPV to develop into cervical cancer. Fortunately, Pap and HPV tests work together to detect abnormal changes as soon as possible. The Pap test can find abnormal cells.⁷ When they are found, healthcare providers can make sure the patient receives the right care and treatment.⁷ If the cells look like they might become cancerous, they may be able to be removed.The HPV test shows if your cells are infected with the HPV virus. Most of the time, your body will eventually clear the HPV by itself. But your healthcare provider will likely want to retest you at another time, just to make sure.Cervical Cancer Screening RecommendationsScreening recommendations depend on your age:

• If you are a woman 21 to 29 years old, a Pap test alone is recommended every 3 years.^4,7 In this age group, about 9 out of 10 HPV infections go away by themselves.⁶ The risk for cervical cancer is very low in this group.
• If you are a woman 30 to 65 years old, co-testing that includes both an HPV test and a Pap test done at the same time is recommended every 5 years. In fact, co-testing is the preferred screening method for this age group according to some guidelines.⁷ That’s because fewer HPV infections go away by themselves in these women, and the risk of cancer is higher.

Co-testing helps to⁴

• Detect abnormal precancerous cells earlier than Pap testing alone
• Detect some types of cervical cancer that are not detected by the Pap test alone
• Possibly decrease the frequency of screening needed

What You Can DoIf you are a woman 21 to 65 years old, regular testing should be part of your personal healthcare. Talk with your healthcare provider about what kind of cervical cancer screening is best for you, and how often you should be tested. Remember, cervical cancer testing isn’t recommended every year. But it is important that you still get a well-woman exam each year, which may include a variety of tests, evaluations, and counseling. A yearly checkup gives your healthcare provider a chance to evaluate your overall health and can help uncover any health problems early on.If you are over 65 and have had recent cervical cancer screening tests that were negative, talk with your healthcare provider about whether or not you should continue testing.If you are 26 years or younger and have not had an HPV vaccine yet, talk to your healthcare provider about getting vaccinated.A vaccine is available in the United States that helps protect against the HPV high-risk types that cause cancer. HPV vaccination can lower your risk of cervical cancer. The vaccine also helps protect against types that cause genital warts.⁸ The vaccine is recommended for males and females ages 9 to 26 years old. Males can be infected and not know it. If they are infected, they can pass the infection to women through sex. Vaccinating males also helps protect women.How the Laboratory Can HelpWhen it is time to be screened, your healthcare provider will collect some cells from your cervix. This specimen is then sent to the laboratory for testing. The laboratory can do both Pap and HPV tests. The laboratory can also test for other sexually transmitted diseases if your healthcare provider thinks this is necessary.You can find more information on cervical cancer screening here.References

1. Tambouret RH. The evolution of the Papanicolaou smear. Clin Obstet Gynecol. 2013;56:3-9.

2. Cervical cancer statistics. Centers for Disease Control and Prevention website. Updated June 12, 2018. Accessed October 18, 2018. https://www.cdc.gov/cancer/cervical/statistics/

3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. Obstet Gynecol. 2013;122:1338-1367.

4. Genital HPV infection-fact sheet. Centers for Disease Control and Prevention website. Updated November 16, 2017. Accessed October 18, 2018. https://www.cdc.gov/std/hpv/stdfact-hpv.htm

5. McGraw SL, Ferrante JM. Update on prevention and screening of cervical cancer. World J Clin Oncol. 2014;5:744-752.
6. Rodríguez AC, Schiffman M, Herrero R, et al. Rapid clearance of human papillomavirus and implications for clinical focus on persistent infections. J Natl Cancer Inst. 2008;100:513-517.

7. Committee on Practice Bulletins— Gynecology. Practice bulletin no. 168: cervical cancer screening and prevention. Obstet Gynecol. 2016;128:e111-e130.

8. Gardasil 9 . Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2016.