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Published on November 24, 2020

Understanding the New Cervical Cancer Screening Guidelines

Cervical cancer was once the leading cause of cancer deaths for women in the United States. Thanks to the development of effective screening tools like the Pap test and HPV test, deaths from cervical cancer have decreased significantly. Education and awareness of these screening tools is essential to prevention, but guidelines for screenings have recently changed. To find out more about cervical cancer and the new screening guidelines, we spoke with Tommy R. Buchanan Jr., MD, a gynecological oncology specialist at Abington – Jefferson Health.

Q: What causes cervical cancer?

Dr. Buchanan: Cervical cancer is caused by a persistent infection of the human papillomavirus, otherwise known as HPV. HPV is not only the most common sexually transmitted disease, according to the Centers for Disease Control and Prevention (CDC), but also the leading risk factor of cervical cancer. Those especially at risk for developing cervical cancer may also have a history of smoking or an immunodeficiency—a disease that weakens the immune system—like HIV.

Q: How can cervical cancer be prevented?

Dr. Buchanan: The cornerstone of cervical cancer prevention is education. First, it’s important to know your chances of having cervical cancer are lower if you received the HPV vaccine as a teenager. This vaccine is most effective if it is administered prior to engaging in any form of sexual activity. Regardless, the most important prevention tool for cervical cancer is screening.

There are three types of tests involved in cervical cancer prevention: the Pap test, the HPV test and HPV and Pap co-testing. Each of these tests involves the insertion of a speculum into the vagina and the use of a special swab or soft brush to collect cells around and inside of the cervix. While the Pap test aims to find cell changes on the cervix that could become cancerous if not treated, the purpose of the HPV test is to find the virus that causes these changes. Co-testing is when the same cells are tested for the HPV virus and cervical changes simultaneously. These tests are usually done in conjunction with pelvic exams and are critical to finding and preventing cervical cancer.

Q: How have the guidelines for the prevention and detection of cervical cancer changed?

Dr. Buchanan: Screening guidelines have recently been updated by the American Cancer Society. It now recommended to start screening patients at age 25, instead of age 21. Thanks to advancements in vaccine coverage, instances of cervical cancer are low among young women under the age of 25.

The most notable change is that the ACS now recommends the HPV test once every five years as the primary diagnostic test for cervical cancer, instead of the Pap test once every three years. This change stems from research showing that the HPV test is more effective than just looking for precancerous changes in the cervix with the Pap test—and it also avoids over testing and unnecessary medical intervention.

Q: How can patients approach their healthcare team about cervical cancer screening?

Dr. Buchanan: The first step is for patients to be comfortable with their provider. I’ve heard many stories where patients saw an OB/GYN or primary care provider who didn’t answer their questions, Women should know that they have the freedom to switch providers at any time. Getting a Pap or HPV test can be nerve-wracking, especially for the first time, so it’s important to have a provider with whom she feels comfortable.

The next and most important step is to convey any and all concerns you have to your provider. If you’re not sure where to start, start with your own history, like if you’ve had the HPV vaccine or if someone in your family has had cervical cancer. It is believed cervical cancer can run in families, so cascade testing—testing family members once one person has been identified with a certain mutable gene—can help greatly with prevention.

The best preventive measure you can take is being open and honest with your healthcare team. It’s important for patients to ask questions and share concerns, even if they think they’re silly. If you’re experiencing anything that feels strange like irregular bleeding, pelvic pain or missed periods, you should share that information with your physician. My advice is this: Don’t be afraid to advocate for yourself, stop smoking and, most importantly, visit your OB/GYN on an annual basis.

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