What’s Going On With Cervical Cancer Screening in US?
“The other ‘quiet’ reason is that the incidence of cervical cancer in the US in women under the age of 21 is 1.7/100,000. This is a real number, and this means that real young women get cervical cancer, and some of them die,” Dr. Harper added.
“However, cytology is only good enough to reduce cervical cancer to 2.8/100,000, so getting Pap testing does not allow us to detect this small but real number of young women with cervical cancer. Adding HPV testing to cytology in this age group just creates a very large number of false positives. Hence, the reality is that we have no perfect system - Gardasil can only reduce the cervical cancer rate to 14/100,000, which is worse than Pap screening and not a way to protect all of the 1.7/100,000 young adolescents from cervical cancer. Hence, we accept that some cervical cancers will not be detected,” she said.
Practice Changes Take Time
Another finding from the CDC survey was data suggesting that women in the 22- to 30-year-old age group were undergoing Pap tests annually instead of every 3 years, as per the new, updated guidelines.
This as well as some of the other findings suggest that it is taking some time for recommendations in the guidelines to filter through to clinical practice. Dr. Harper offers a few suggestions as to why this is the case: physicians may not be understanding the evidence for the change in the screening recommendations; reimbursement for the test still occurs; the patient feels at risk and requests frequent testing (“or the same testing as my sisters had…”); and nursing staff may set up the clinic rooms not understanding or accepting the change in guidelines.
The American Cancer Society at March 14, 2012 released new screening recommendations for the prevention and early detection of cervical cancer. Screenings are tests for women who have no symptoms of cervical cancer. Among the changes: the American Cancer Society no longer recommends that women get a Pap test every year.
During the past few decades, screening has reduced deaths from cervical cancer, as doctors have been able to find cancer early and treat it, or prevent it from ever developing. Researchers continue to find out more about what causes cervical cancer, and the best ways to screen for it.
There are 2 types of tests used for cervical cancer screening.
The Pap test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early, when it’s easier to treat.
The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don’t cause these problems. The HPV test may be used along with a Pap test, or to help doctors decide how to treat women who have an abnormal Pap test.
The American Cancer Society regularly reviews the science and updates screening recommendations when new evidence suggests that a change may be needed. The latest recommendations are:
All women should begin cervical cancer screening at age 21.
Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened.
Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or exposure to the drug DES. They should talk with their doctor or nurse.
In short, the American Cancer Society no longer recommends that women get a Pap test every year, because it generally takes much longer than that, 10 to 20 years, for cervical cancer to develop and overly frequent screening could lead to procedures that are not needed.
“All past analyses have shown that it takes about 10 years for physician behaviors to change to reflect the latest change in screening recommendations,” Dr. Harper noted.
MMWR. 2012;61:51,52;1038-1047.
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Zosia Chustecka