CDC: Not All Women Following New Guidelines for Cervical Cancer Screening

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February 1, 2013

Two new studies from the Centers for Disease Control and Prevention (CDC) found that recent screening guidelines that call for less cervical cancer screening are generally being followed by younger women, but too many older women and women who have had total hysterectomies are still undergoing the screening, which is not recommended.

One of the two studies found that most women 30 and younger are following new national recommendations to have the screenings once every 3 years instead of annually. However, the second report found that nearly 60% of women who have had a total hysterectomy are still being screened for cervical cancer, even though guidelines recommend against such screening because of the very low risk of cervical cancer in these women. According to the CDC, unnecessary screening can result in false positives and lead to further unnecessary testing and procedures. Both articles were published in the CDC's Morbidity and Mortality Weekly Report (MMWR) in January 2013.

About 12,000 women were diagnosed with cervical cancer in 2010 and close to 4,000 women died as a result of the cancer, which is most commonly found in women 35 to 55, according to the U.S. Preventive Services Task Force (USPSTF). This type of cancer is usually caused by human papillomavirus, known as HPV, which is transmitted during sex. Two types of HPV, types 16 and 18, account for about 70% of cervical cancers in the U.S.

Depending on a woman's age, screening may involve a Pap smear (also known as Pap test) or a combination of a Pap smear and an HPV test. The Pap test can detect abnormal cells in the cervix that may progress to cancer. An HPV test can identify infection with specific types of HPV that are associated with a high risk for cervical cancer. Samples for these tests are typically collected in a doctor's office or a clinic during pelvic exams. By screening for cervical cancer, cases can be detected earlier and treatment can begin sooner, when it is likely to be most effective.

In 2012, three major health organizations, the USPSTF, the American College of Obstetricians and Gynecologists (ACOG), and the American Cancer Society revised previous guidelines that called for annual testing. They now recommend that women age 21 and older have a Pap smear every 3 years. Beginning at age 30, a woman may opt to continue this schedule or get tested with a Pap and HPV test every 5 years. These organizations also advise against screening for most women who have had a total hysterectomy not linked to cancer and for women 65 and older who have had normal Pap test results during the preceding 10 years. Cervical cancer screening is not recommended for women younger than 21.

"The good news is we are focusing our public health efforts on women at highest risk, while decreasing screening for women under age 21, when cervical cancer is rare and screening is not recommended," said Keisha Houston, DrPH, Epidemic Intelligence Service officer with CDC's Division of Cancer Prevention Control. "We need to remain vigilant and increase screening among women who would benefit most from this preventive service."

Key statistics from the two studies include:

  • The percentage of women aged 18-21 years who reported never being screened increased from 23.6% in 2000 to 47.5% in 2010.
  • For women aged 30 years and older who had a total hysterectomy, Pap testing declined from 73.3% in 2000 to 58.7% in 2010.

For more about who should be screened, with which test(s) and how often, see the Cervical cancer screening pages for Young Adults, Adults and Adults 50 and Up.

The CDC advises women to follow up with their health professional to find out the results of a Pap smear and/or HPV test and determine if any follow-up, including treatment, is needed.

Women without health insurance may qualify for a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

(January 4, 2013) Centers for Disease Control and Prevention. More Women Getting Pap Tests as Recommended. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6151a2.htm through http://www.cdc.gov. Accessed January 13, 2013.

(January 4, 2013) Centers for Disease Control and Prevention. Cervical Cancer Screening Among Women by Hysterectomy Status and Among Women Aged ≥65 Years — United States, 2000 –2010. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6151a3.htm through http://www.cdc.gov. Accessed January 13, 2013.

(May 30, 2012) Centers for Disease Control and Prevention. Cervical Cancer. Available online at http://www.cdc.gov/cancer/cervical/index.htm through http://www.cdc.gov. Accessed January 13, 2013.

(2012) Centers for Disease Control and Prevention. Cervical Cancer Screening Guidelines for Average Risk Women. PDF available for download at http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf through http://www.cdc.gov. Accessed January 13, 2013.

(Reviewed September 5, 2012) Centers for Disease Control and Prevention. Cervical Cancer Screening. Available online at http://www.cdc.gov/cancer/cervical/basic_info/screening.htm through http://www.cdc.gov. Accessed January 13, 2013.

(March 2012) U.S. Preventive Services Task Force. Screening for Cervical Cancer. PDF available for download at http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerfact.pdf through http://www.uspreventiveservicestaskforce.org. Accessed January 13, 2013.