Most deaths from cancer of the cervix (the lower part of the uterus, or womb) can be avoided by having regular checkups and and cervical cancer screens. Cervical cancer is slow-growing and can take several years to develop. Most often, cancerous cells are seen in women 40 years of age or older. Routine screening can help identify cervical cancer early on, at a time when it is highly curable. Screening even finds precancerous lesions that can be monitored or removed before cancer ever starts to develop.
Cervical cancer screening guidelines for young women from the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), and the U.S. Preventive Services Task Force (USPSTF) recommend that women between the ages of 21 and 29 have a Pap test every 3 years.
ACOG, USPSTF and ACS guidelines recommend more frequent screening for women with risk factors such as exposure to DES (diethylstilbestrol) in utero, previous diagnosis of a high-grade precancerous cervical lesion or cervical cancer, HIV infection, or a compromised immune system. (See the section on Risk Factors in the Cervical Cancer article.)
A Pap test for women younger than 21 is not recommended because the incidence of cancer in this age group is very low. False-positive results may occur due to normal cell changes and are somewhat common. The false-positive results may generate unnecessary and costly treatment as well as emotional anxiety.
Pap tests are available from family planning clinics and public health departments as well as from healthcare providers (including pediatricians, family physicians, obstetrician-gynecologists, and nurse practitioners). Even if you do not need a Pap test each year, for most women an annual well-woman exam is still recommended, reminds ACOG.
In general, screening for the presence of human papilloma virus (HPV DNA test) is not recommended in women younger than age 25 because infections with HPV are relatively common in this age group and often resolve without treatment or complications. However, HPV testing may be used as a follow-up test for women between the ages of 21 and 29 years who have abnormal results on a Pap test known as "atypical squamous cells of undetermined significance" (ASCUS) [see Pap Test Terminology]. Results may be used to determine the need for colposcopy, a procedure that allows a health practitioner to visually inspect the vagina and cervix under magnification for the presence of abnormal cells.
Significant changes to these recommendations may be on the horizon, however. The Food and Drug Administration (FDA) approved an HPV DNA test as a primary screening tool for cervical cancer, meaning it may be used without a Pap test. Individual health organizations have yet to update their screening recommendations, but an expert panel issued interim (temporary) guidelines in 2015. These guidelines say that:
- The HPV test may be offered to women aged 25 and older without a Pap test.
- If initial results are negative, women should be screened again no sooner than 3 years.
Women interested in this new option should talk to their healthcare provider. The interim guidelines acknowledge that more studies are needed to further evaluate the HPV test and its role in cancer screening. For example, there are still questions about whether age 25 is the best age to start offering it as a primary screening option and how often women should be screened.
Sources Used in Current Review
(Updated 2012 August 13). HPV- Associated Cancer Diagnosis by Age. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/cancer/hpv/statistics/age.htm. Accessed 6/16/15.
(2012 March). Screening for Cervical Cancer. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed 6/16/15.
Moyer, VA on behalf of the U.S. Preventive Services Task Force. (2012 June 19). Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full. Accessed 6/16/15.
(Reviewed 2014 March 17). Cervical Cancer Prevention and Early Detection. American Cancer Society. Available online at http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf. Accessed 6/16/15.
(Reviewed 2014 September 9). Pap and HPV Testing. National Cancer Institute. Available online at http://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet. Accessed 6/16/15.
Saslow, D. et al. (2012 March 14). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21139/full. Accessed 6/16/15.
Barclay, L. (2015 January 9). New Guidance Recommends HPV DNA Test for Primary Screening. Medscape Medical News. http://www.medscape.com/viewarticle/837832. Accessed 6/16/15.