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Navigating the Cervical Cancer Screening Guidelines

Eduardo Mercurio, MD, Obstetrics and Gynecology
The Chester County Hospital and Health System

Published: October 11, 2010

The annual gynecological exam, when the physician examines a woman's breasts, thyroid, heart, lungs and pelvic organs, is a woman's opportunity to receive preventive health education, early detection, screening and intervention. The pelvic exam consists of a bimanual exam (also called the "internal") and direct inspection with the speculum, but it does not necessarily include a Pap test each year, which has some women asking why.

Current guidelines for cervical cancer screening address both pap smears and HPV testing. The Pap test is designed exclusively to screen for cervical cancer, although on rare occasions it has diagnosed endometrial cancer (cancer from the lining of the uterus). It is possible to detect if a woman has an infection or unhealthy cervical cells. The HPV test, testing for a virus which is associated with cervical cancer, is performed either from the same specimen as the Pap smear or from a separate sample from the cervix. Additionally, the HPV test is used to determine which women with Pap smears showing Atypical Squamous Cells of Undetermined Significance (ASCUS) will need further testing.

Although it rarely causes symptoms, HPV is a small virus that can cause warts and certain cancers of the skin lining in the lower genital tract or mouth. It is an extremely common sexually transmitted disease among women and men: estimates have put the likelihood of getting an HPV infection at about 75% to 90%. There have been more than 100 HPV types identified, and an additional 30 types have been detected. They are all somewhat different in genetic structure, and these differences determine the location and type of lesion they can cause.

The HPV types that infect the genital tract can be divided into two groups - low risk and high risk. The low-risk types are typically not found in cancers, with the most commonly detected type being genital warts. The high-risk HPV types have been identified in cancers of the vagina, vulva, anus, penis and cervix. Cervical cancers are usually slow-growing, and about 80% are caused by certain high-risk strains of HPV.

Most people who get HPV are not aware they have it since it often goes away undetected; but 2-5% of women will have a Pap test that shows abnormal cell changes due to HPV. Bleeding during or after intercourse, irregular bleeding between periods, unexplained pelvic pain or a persistent abnormal discharge are most often due to other causes; but since they may occasionally indicate cervical cancer, they should always be evaluated.

Cervical Cancer Screening Guidelines:

  • Women should have their first cervical cancer screening (Pap test) at age 21.
  • Women ages 21-30 should have cervical cancer screening every two years.
  • Women age 30 and older who have had normal pap smear with negative HPV test or three consecutive normal Pap smears, may only need to be screened once every three years.
  • Women who have been vaccinated against HPV should still follow the same screening guidelines as unvaccinated women.

Even though the new cervical screening guidelines recommend less frequent Pap tests, women still need to have a yearly gynecologic exam to review their individual preventive health issues and to rule out any problems with their reproductive organs.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 10/12/2010