Most deaths from cancer of the cervix (the lower part of the uterus, or womb) could be avoided if women had regular gynecological checkups with Pap smears. This 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
Women who haven't been screened for cervical cancer in 3 years or more or who have never been tested are especially urged to have a Pap smear.
Several organizations recommend that women 30 years of age or older be screened for the presence of human papilloma virus (HPV) with an HPV DNA test in addition to a Pap smear. Persistent infections with certain types (strains) of HPV are now known to be the major risk factor for cervical cancer. Two types of HPV, types 16 and 18, account for about 70% of cervical cancers in the U.S. Cigarette smoking and a compromised immune system have also been associated with the persistence of the HPV infection, which may progress to cancer.
The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) recommend the following for women ages 50 to 65:
- A Pap smear and an HPV test every 5 years is preferable, although a Pap test alone every 3 years is also acceptable.
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 smears 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 such as exposure to diethylstilbestrol (DES) in utero, previous diagnosis of cervical cancer, HIV infection, or a compromised immune system. If you have these risk factors, you should be tested more frequently. Ask your health care 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 smear each year, for most women an annual well-woman exam is still recommended, reminds ACOG.
Sources Used in Current Review
U.S. Preventive Services Task Force. Screening for Cervical Cancer. Release Date: March 2012. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm through http://www.uspreventiveservicestaskforce.org. Accessed March 2012.
Moyer, VA on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, March 6, 2012, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full through http://www.annals.org. Accessed March 2012.
American Cancer Society. New Screening Guidelines for Cervical Cancer. Article date: March 14, 2012. Available online at http://www.cancer.org/Cancer/news/News/new-screening-guidelines-for-cervical-cancer through http://www.cancer.org. Accessed March 2012.
Reuters. Wait longer between Pap tests, doctors say. October 22, 2012. Available online at http://www.reuters.com/article/2012/10/22/health-cancer-papsmear-idUSL3E8LM84D20121022 through http://www.reuters.com. Accessed November 2012.
ACOG. Ob-Gyns Recommend Women Wait 3 to 5 Years Between Pap Tests. October 22, 2012. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Ob-Gyns_Recommend_Women_Wait_3_to_5_Years_Between_Pap_Tests through http://www.acog.org. Accessed November 2012.