Understanding the New Recommendations for Cervical Cancer Screening

Wednesday, April 18, 2012 - 4:04pm
Director, Minimally Invasive Surgery, Department of Gynecologic Oncology

Just last month, the U.S. Preventive Services Task Force (USPSTF) released updated cervical cancer screening recommendations. Similar guidelines were also published by a collaborative group consisting of The American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP).

The new recommendations guide women on when and how frequently they should be tested using the two current types of cervical cancer screening: cervical cytology, more commonly known as the Pap smear or Pap test, and HPV testing.

Summary of the new recommendations

  • No Pap tests in women younger than age 21, where previous recommendations advised women to begin screening as soon as they became sexually active
  • Pap tests every 3 years, rather than annually, for women ages 21 to 29
  • Pap test and HPV testing every 5 years, or pap test alone every 3 years, for women ages 30 to 65
  • No testing for women over 65-years-old who are at average risk and who have had consistent, normal screening test results
  • After a hysterectomy, no screening is needed if there is no history of cervical dysplasia and the cervix has been removed
  • No change in guidelines for HPV vaccination

Why the changes?

These recommendations reflect a delicate balance between benefits and harms, ensuring that women still reap the benefits of early detection while minimizing the risk of overtreatment.

We now know that it takes several years for human papillomavirus (HPV), the infection that is responsible for nearly all cervical cancers, to develop into cervical dysplasia or cancer. Furthermore, many women who have HPV may clear the infection naturally in a few years. Annual testing may lead to unnecessary treatment - and unnecessary side effects – of early lesions and abnormalities that may never pose any harm.

One size does not fit all when it comes to cancer screening

It’s important to note that these recommendations are for women at average risk of developing cervical cancer. Those at high risk, such as women with prior abnormal pap smears, organ transplants or those with HIV, may need to follow a different screening schedule. Every woman should talk with her doctor about her individual screening needs.