Cervical Cancer Screenings: Are You Following Best Practice?

Cervical cancer screening guidelines were changed a few years ago, yet many physicians continue to perform them according to the prior guidance.

“As primary care physicians, we are trained to do preventative screening, such as for cervical cancer,” said Rebecca Lewis, DO, FACOFP. “However, many family physicians are following old guidance, which means unnecessary procedures for patients.”

Cervical cancer is the fourth most common cancer worldwide, with over 600,000 new cases annually and approximately 350,000 cancer-related deaths per year, according to a report published to the National Library of Medicine.

HPV tests are recommended over a Pap test

(Source: National Cancer Institute)

A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer.

The Pap test has been the mainstay of cervical cancer screening for decades, but HPV tests are a newer method of cervical cancer screening. Two HPV tests are approved by the Food and Drug Administration (FDA) and other HPV tests are approved as part of an HPV/Pap co-test. (An HPV/Pap co-test is when the tests are done together.)

For patients, an HPV test and a Pap test are done the same way--by collecting a sample of cervical cells with a scraper or brush.

While all three tests can find cervical cancer precursors before they become cancer, studies have shown that HPV tests are more accurate and reliable than Pap tests. Also, you can rule out disease with HPV tests, so they don’t have to be repeated as frequently.

Cervical cancer screenings every five years instead of three

The change from three to five years is due to better screening through HPV tests. The tests are more accurate at detecting who is at higher risk of developing cervical cancer.

This is the prevailing global medical guidance, but it should be noted the final recommendation for patients in the United States is under review by the appropriate governing bodies. The US Preventive Services Task Force (USPSTF) is recommending every five years with the HPV test.

Begin cervical cancer screening at 25 years old, instead of 21 years old

(Source: National Cancer Institute )

Using information from new studies, the American Cancer Society concluded that the benefits of cervical cancer screening do not outweigh the harms for people aged 21 to 24 years old.

This is an important change related to HPV vaccines. The first cohort of women who received the HPV vaccine when they were younger are now in their 20s and eligible for cervical cancer screening. HPV vaccines are very good at preventing HPV infections, particularly infection with HPV types 16 and 18, the types that cause most cervical cancers. The vaccines have led to a drop in HPV infections and cervical precancer in this age group.

Also, in young women, most HPV infections go away on their own. Screening people in this age group often leads to unnecessary treatment, which can have side effects.

Let patients know you can do the screening

Many patients do not know their family physician can do their cervical cancer screening, or other screenings for which they might otherwise see a specialist. Whether on your website, office signage, handouts or during appointments, communicate with patients all the ways you can support them as their family doctor.