Nearly all cervical cancers are caused by human papilloma virus (HPV), but not all HPV strains cause cervical cancer. About a dozen HPV strains, such as HPV 16, 18, 33, 35, and 39, are considered "high risk" because persistent infections — those that do not resolve without treatment — are linked to an increased risk for cervical and vaginal cancer. Two HPV types, 16 and 18, cause 70% of all cervical cancers.
Cervical cancer is a slow-growing cancer that can take several years to develop and most often is 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 so they can be removed before cancer ever starts.
Recommendations: Ages 50 to 65 | Over age 65
The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) recommend that women ages 50 to 65 have a Pap test and an HPV test every 5 years, although a Pap test alone every 3 years is also acceptable.
Women who haven't been screened for cervical cancer for several years or who have never been tested are especially urged to have a Pap test.
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.
Recommendations: Over age 65 | Ages 50 to 65
ACOG, USPSTF and ACS recommend against screening for cervical cancer for women over the age of 65 who have had negative results on adequate prior screening. Guidelines define adequate prior screening as 3 consecutive negative Pap tests or 2 consecutive negative HPV tests in the prior 10 years, with the most recent within 5 years.
How often you should be tested depends on your risk factors. Risk factors include persistent infection with a high-risk strain of HPV, exposure to diethylstilbestrol (DES) in utero, previous diagnosis of cervical cancer, HIV infection, or a compromised immune system. (See the section on Risk Factors in the Cervical Cancer article.) If you have these risk factors, you may be tested more frequently. Ask your healthcare provider for a recommendation on frequency and if this test is still appropriate for you. If you have had a hysterectomy, discuss whether continued screening is of value. In some cases, it is.
Even if you do not need a Pap test each year, for most women an annual well-woman exam is still recommended, reminds ACOG.
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. Available online at http://www.medscape.com/viewarticle/837832. Accessed 6/16/15.