The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening. In 1975, the rate was 14.8 per 100,000 women. By 2011, it decreased to 6.7 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.3 per 100,000 women in 2011 . The American Cancer Society (ACS) estimated that there would be 12,900 new cases of cervical cancer in the United States in 2015, with 4,100 deaths from the disease . Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 527,624 new cases of the disease and 265,672 resultant deaths each year .When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed.
The American Cancer Society recommends that women follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from starting.
- All women should begin cervical cancer testing (screening) at age 21.
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- Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group unless it is needed as after an abnormal Pap test result.
- Beginning at age 30, women should be screened with a Pap test combined with an HPV test every 5 years as long as the test results are normal. This is called co-testing and should continue until age 65.
Another reasonable option for women 30 to 65 is to get tested every 3 years with only the Pap test./p>
- Women over age 65 who have had regular screening in the past 10 years with normal results should stop cervical cancer screening. Once stopped, it should not be started again.
Women with a history of a serious pre-cancer, such as CIN2 or CIN3 should continue to have testing for at least 20 years after that condition was found, even if the testing goes past age 65.
- Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer). Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above.
- Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team.
- Women of any age should NOT be screened every year by any screening method if their Pap tests have been normal and they do not have HIV infection or other cause for a weakened immune system.
- Women who have been vaccinated against HPV should still follow these guidelines for their age groups.
Some women believe that they can stop cervical cancer screening once they have stopped having children. This is not true. They should continue to follow American Cancer Society guidelines.
Although annual (every year) screening should not be done, women who have abnormal screening results may need to have a follow-up Pap test (sometimes with a HPV test) done in 6 months or a year.
The American Cancer Society guidelines for early detection of cervical cancer do not apply to women who have been diagnosed with cervical cancer or cervical pre-cancer. These women should have follow-up testing and cervical cancer screening as recommended by their health care team.
Sources: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2016/10/cervical-cancer-screening-and-prevention
https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html
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