For over 50 years, routine use of the Pap test to screen for cervical cancer has reduced deaths from the disease by more than 70%. A Pap test is a standard way healthcare providers can check to see if there are any changes in the cervix that might cause concern. The Pap test involves looking at a sample of cells from the cervix under a microscope to see if there are any that are abnormal. It is a good test for finding not only cancer, but also finding cells that might become cancerous in the future.
Usually, healthcare providers perform the Pap test as part of a routine pelvic exam at recommended intervals. However, a Pap is not always done at the time of a routine pelvic exam, so it is important to ask your healthcare provider if a Pap was done.
In 2012, the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) released new guidelines for the prevention and early detection of cervical cancer. The guidelines generally advise a reduction in the number of tests women get over their lifetime to better ensure that they receive the benefits of testing while minimizing the harms, and include a preference for co-testing using the Pap test and a highly sensitive HPV test for women age ages 30 to 65.
The updated guidelines recommend:
- Women should not be screened before age 21
- Women 21 to 29 should be screened with the Pap test alone (conventional or liquid-based) every three years. HPV testing should NOT be used for screening in this age group.
- For women 30 and over, the preferred approach is the Pap test plus HPV testing (“co-testing”) every five years. Continued screening with the Pap test alone (without HPV testing) every three years is an acceptable alternative. While screening with HPV testing alone is promising, at this time it is not recommended for most clinical settings.
- Screening is not recommended for women over age 65 who have had at least three consecutive negative Pap tests or at least two negative HPV tests the last 10 years, with the most recent test in the last 5 years. Women in this age group who have a history of cervical pre-cancer (CIN2 or a more severe diagnosis) should continue routine screening for at least 20 years, even if this extends beyond age 65.
- Women who have undergone a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer or pre-cancer should not be screened anymore.
- Women who have been vaccinated against HPV should follow the age-specific recommendations in these guidelines (for unvaccinated women). Currently, there are no alternative screening recommendations for women vaccinated against HPV.
The new guidelines are not intended for women with a history of cervical cancer, exposure to DES during a pregnancy, or women who are immunosuppressed (e.g. HIV positive).
It is important for women to know if a Pap test was performed because it is possible to have a pelvic exam without a Pap test. It is also important that women know and understand their Pap test results and follow through with any recommendations made by their healthcare provider. Some abnormal Pap tests will be followed by colposcopy (examination of the cervix using a magnifying device to see the cervix more clearly) and biopsy of any abnormal appearing areas on the cervix. Any pre-cancerous areas can then be seen and, if needed, treated by a woman’s healthcare provider.
Current cervical cancer screening guidelines state that women with a slightly abnormal Pap test result (called “ASC-US”) and a negative HPV test can be screened again with co-testing in 3 years, or with the Pap test alone in 3 years. Women with a negative Pap result but a positive HPV test can either be rescreened with co-testing in one year, or tested with a test that can determine specific types of HPV (HPV16 and HPV 18).
Major educational efforts are being directed toward the appropriate approach to cervical cancer screening in adolescent girls (less than 21 years of age). Sexually active girls and young women frequently have HPV infections and will even have abnormal Pap tests. Many of these young women will have spontaneous resolution of their infections and abnormal Pap test without the need for their gynecologists to intervene. Also, cancer in this age group is exceedingly rare.