Cervical cancer affects over 13,000 women per year resulting in over 4,000 deaths if left untreated. Previously, cervical cancer screening guidelines for cervical cancer detection have caused many patients and providers to over-treat pap smears, causing abnormal findings thereby causing anxiety and unnecessary worry in patients.
In the past, Pap smears were done to detect any precancerous cells or changes, including the earliest forms of dysplasia (CIN 1), in order to prevent the progression to cervical cancer. The most common causes of cervical cancer are high-risk forms of the Human Papilloma Virus (HPV). HPV causes two types of changes: genital warts and cervical cancers. Over the last 40 years, the deaths from cervical cancer have decreased by over 50 percent because more women are having PAP tests. Most women who are infected with high-risk HPV will never have any symptoms.
There have been several large studies that show great benefit to getting a PAP with HPV testing at longer screening intervals. But wait, the Pap test is not for everyone! The current guidelines recommend:
• Women under age 21 should not be screened because of the high false-positive rates and even if a woman is under 21 and exposed to HPV, most women clear the HPV virus on their own.
• Women screening for cervical cancer every three years, Pap test and HPV testing should NOT be used unless needed as follow-up after an abnormal Pap test result.
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• Women aged 30 to 65 years, preferred screening is Pap test WITH an HPV test every five years (co-testing) until age 65. Another option is just a Pap test every three years.
• Women older than age 65 who have never previously had moderate or high-risk changes to their cervix require no further screening for cervical cancer.
These guidelines do not apply to women who are immunosuppressed, are HIV positive, or have a previous history of high-risk changes to the cervix.
A woman who has had a total hysterectomy — removal of the uterus and cervix — should stop screening, unless the hysterectomy was done as a treatment for cervical pre-cancer or cancer.
A woman who has had a hysterectomy without removal of the cervix should continue cervical cancer screening according to guidelines. Women who have had a hysterectomy and have no history of high-grade precancerous lesions or cervical cancer require no further cervical cancer screening.
Since cervical dysplasia progresses very slowly it can easily be treated even if caught years after it began. With cervical cancer or changes in the cells of the cervix due to HPV, most cases will resolve on their own within 6-12 months without treatment. Women with a history of high-risk HPV strains and cervical changes should be checked annually until the cytology has been negative for 20 years. Women of any age with normal Pap smears should not have a Pap every year or be screened for HPV every year. For those who received the HPV vaccine series, they should follow the screening guidelines previously discussed according to their age group.
Keisha Ellis, C-FNP is a certified family nurse practitioner for Eastern New Mexico Medical Group’s Quick Care. The advice offered in this column is that of the author.