An update to a previously reported study, which confirmed that testing for human papilloma virus (HPV) may be the best way to identify women at increased risk of cervical cancer, supports the idea that HPV-negative women older than 40 years of age may not need to be tested as often as current guidelines recommend. The study was conducted in the Netherlands and was recently published in the British Medical Journal.
The traditional screening test for cervical cancer is the Papanicolaou test (Pap test). This involves obtaining samples of cells from the cervix and examining them under a microscope. Cells that appear abnormal can signal the presence of cancer or, in many cases, changes that may lead to cancer in the future. Most cases of cervical cancer are caused by infection with HPV, especially two particular types that are considered especially high-risk. In recent years, testing for these high-risk types of HPV has been incorporated into screening protocols.
The goal of screening is to detect cervical cancer in the earliest stages when it is most treatable. Although only the Pap test can detect cancer (or the changes referred to as pre-cancer), screening for HPV infection helps identify women who may need closer monitoring. Current U.S. guidelines advise that women begin screening at age 21 with a Pap test every 3 years and then have both a Pap test and an HPV test every 5 years from age 30 to 65.
The recent report is an update to a population study published in 2012, which confirmed that this co-testing in older women every 5 years protects against cervical cancer better than does cytology alone. Recently, the Netherlands proposed extending the screening interval in HPV-negative women over 40 years of age from 5 to 10 years for cost reasons. This spurred the investigators to re-analyze their data. They confirmed (now with even more follow-up than in the 2012 report) that this longer interval appears justified. Whether this change will be made in other countries remains to be seen.
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Dijkstra M, et al. Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands. BMJ 2016;355:i4924. Available online at http://www.bmj.com/content/355/bmj.i4924. Accessed November 30, 2016.
(October 5, 2016) Herman, A. Cervical Screening Window Could Be Extended Beyond 5 Years in Some Women, Study Suggests. JournalWatch. Available online at http://www.jwatch.org/fw112106/2016/10/05/cervical-screening-window-could-be-extended-beyond-5. Accessed November 30, 2016.
(October 06, 2016) Davenport, Liam. 10-Year Interval for Cervical Cancer Screening Proposed. Medscape Medical News, Oncology. Available online at http://www.medscape.com/viewarticle/869887. Accessed November 30, 2016.
(October 6, 2016) Cervical screening every 10 years for healthy women is 'safe.' PubMed Health. Available online at https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2016-10-06-cervical-screening-every-10-years-for-healthy-women-is-safe/. Accessed December 20, 2016.