Cervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare. The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.
The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established. Thankfully, most HPV infections are short-lived and not detected within 1-2 years. Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.
More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50. HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.
We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers. ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation. Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.
Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.
…..Breast cancer and Lynch syndrome genes are carried by over one million people in the United States, and these two conditions are associated with the most common hereditary gynecological cancers. At present, only a very small percentage of the women who carry these genes have been identified. Therefore, the protocols that can be used to decrease the risk of dying from the cancers that these genes can cause are not being instituted.
…..Our family history will be the first indication that these genes may be a part of our genetic pool, and this can lead to testing for our carrier status. If identified, the cancer screening tests start earlier for the individual carrier and for their relatives in future generations.
…..We must remember that, based on family history, about ten percent of women are at an increased risk for a gynecological cancer. Due to the increased risk of breast, ovarian, colorectal, and prostate cancer, which is determined from the family history, a more intense and earlier testing program may be needed.
…..A woman with a first degree relative with breast cancer has an increased risk for developing that cancer, and it is greater if that cancer was found in that relative before the age of 50. A first degree relative is a parent, brother, sister, or child.
…..Cervical cancer in the United States has been dramatically reduced over the past 30 years due to the widespread testing of cervical cells with the use of the Pap smear. The cervical screening program is constantly evolving as more studies mature the guidelines. The American College of Obstetrics and Gynecology (ACOG) in November of 2012 issued a new Practice Bulletin, which gives new guidelines to improve cervical cancer screening, based on the latest studies. This will be a short summary of these guidelines:
- The cervical cancer screening program begins at age 21 regardless of the onset of sexual activity.
- With women 30 to 65 years of age, cervical cancer screenings should not be performed as often as annually. Annual well woman exams are still recommended and extremely important!
- For women ages 21 to 29, Pap smears should be done every 3 years.
- For women ages 30 to 65, Pap smears should also be done every 3 years.
- Co-testing (Pap smears and HPV testing) should not be performed with women 21 to 29 years of age.
- Co-testing should occur every 5 years with women 30 to 65 years of age.
- With adequate screening history, cervical screening can be stopped after age 65.
- After a hysterectomy in which the cervix has been removed, screening can be stopped.
- Any woman who has received the HPV vaccine should be screened by the same guidelines.
…..As always, all of this information should be discussed with your health care provider who will establish an individual plan for you. Remember all recommendations may be modified based on the individual’s personal history.