The American Congress of Obstetricians and Gynecologists (ACOG) has published new guidelines for screening for cervical cancer. Screening is done to identify changes in cells of the cervix which could lead to cancer. Screening tests most commonly used and recommended are Pap test and Human Papillomavirus (HPV) test. Recently U.S. Food and Drug Administration (FDA) approved First HPV Test for Primary Cervical Cancer Screening. Pap test was earlier recommended to be done every year but this has changed recently as clinical studies over past decades has shown that yearly Pap test has no overall advantage compared to doing Pap test 3 yearly. But ACOG still recommends visiting health care provider for well-women care and any healthcare or information.
Latest Routine cervical cancer screening guidelines are as follows:
- Cervical cancer screening should start at the age of 21.
- Women aged 21-29 years should have a Pap test every 3 years.
- Women aged 30-65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.
- Women should stop having cervical cancer screening after age 65 years if they do not have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.
- Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth should not follow these routine guidelines.
Guidelines also mention that if the patient has abnormal screening test results then additional testing and treatment may be required or health care provider may advise resuming routine screening.
Other recommendations given in the guidelines are “For women aged 30-65 years, the combination of a Pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the Pap test results are normal. If the results of both the HPV test and the Pap test are normal, the chance that mild or moderate dysplasia will develop in the next 4-6 years is very low.”
Guidelines also mention reasons why HPV testing is not done in women younger than 30 years. Reason being that HPV infection is very common is women younger than 30 years and it goes way on its own. A positive HPV test in that age group will become negative without any treatment.
If a woman has had a hysterectomy then she also may have to continue screening for cervical cancer. Whether screening is needed or not depends on reason because of which hysterectomy was done, whether cervix was removed along with it and whether a woman has a history of moderate or severe cervical dysplasia.
