Cervical Cancer Screening Guidelines for Average Risk Women

January is Cervical Health Awareness Month which presents the perfect opportunity to discuss cervical cancer screening and recommendations.

The Pap smear is the screening test for cervical cancer and is generally recommended to start at age 21. It is named for Dr. George Papanicolaou, a Greek cytopathologist, who created the test in the late 1920s.

A Pap requires a pelvic exam to collect cells from the cervix. These cells are examined using cytology for normal or abnormal features. When cells appear abnormal, Pap results are reported as abnormal. Abnormal results can be further reported as unsatisfactory, atypical, low-grade, or high-grade.

Another feature of modern cervical cancer screening is testing for Human Papilloma virus (HPV). HPV is an incredibly common sexually transmitted infection that is found in 99% of all cervical cancers. It is estimated that up to 80% of all sexually active individuals has had HPV. Although this number is high, about 90% of HPV infections are cleared within 2 years. Younger women are more likely to clear HPV infections, which is why HPV screening is not recommended in women age 21 to 29. HPV testing can be used, however, to triage certain atypical cytology results in this age group.

The consensus recommendations for cervical cancer screening are provided by the American Society for Colposcopy and Cervical Pathology. These are standard screening guidelines for average risk women.

  • Those ages 21-29 need cytology alone every 3 years.
  • Those ages 30-64 need HPV testing with cytology (Cotesting) every 5 years
  • At age 65, cervical cancer screening can be discontinued with adequate negative prior screening
  • A patient who has undergone a hysterectomy (with removal of uterus and cervix) does not need additional cervical cancer screening if they have no history of high-grade dysplasia or cervical cancer. A patient who has only undergone a supracervical hysterectomy (removal of the uterus with preservation of the cervix) still needs to observe standard age-appropriate cervical cancer screening.
  • Persons who have been vaccinated for HPV still need to undergo standard cervical cancer screening. Vaccination does not allow for exemption from screening, it just protects from the main genital wart and cancer-causing strains of HPV.
  • Finally, a person with no prior sexual activity who is age 21 or older is not exempt from cervical cancer screening. While one can conclude that patients with no prior sexually history should be at exceptionally low risk for acquiring a sexually transmitted virus, there is no guideline that recommends forgoing cervical cancer screening in this population.
  • Depending on your age and risk factors, your cytology results +/- your HPV results will be considered to determine whether your screening is normal or abnormal. This will further determine whether you need repeat testing, more definitive testing, or treatment. Only your qualified healthcare provider can make these determinations as they are customized to each specific person.

    So remember, the mere presence of HPV or abnormal cells on a Pap Smear is not cause for panic. An abnormal Pap does not mean that you have cancer. Close follow up and compliance with repeat testing and treatment may seem annoying, but it can prevent you from developing cervical cancer, and that’s pretty incredible.

    About the author: Charis Chambers MD is a tenacius and resilient physician, specializing in Pediatric and Adolescent Gynecology in Houston, Texas. Charis’s passion is to #changethecycle in an effort to break generational misconceptions in women’s health.

    For more information, follow Charis @theperioddoctor

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