Dear Doctor: What are the updated guidelines for cervical cancer screening? I’m 62 and want to know what is recommended going forward. Is an annual pelvic exam still necessary if a Pap smear isn’t being done? And have guidelines changed for teens and 20-somethings?
Dear Reader: You’ve asked a lot of excellent questions that will have a broad spectrum of readers interested. And you’re right, screening guidelines are changing.
A Pap test, also called a Pap smear, is used to screen for cervical cancer. It’s a routine procedure that checks for cell changes on the cervix, which is the opening of the uterus. The test looks for abnormal cells that might become cervical cancer if not treated appropriately.
During a Pap smear, cells and mucus from the cervix are collected and then examined under a microscope. Cells from the same sample can also be used for an HPV test, to check for presence of the human papillomavirus, the most common sexually transmitted infection. Women with HPV have a higher risk of developing cervical cancer than women who do not have HPV.
Guidelines from the American Cancer Society as well as the American Congress of Obstetricians and Gynecologists recommend that all women should begin cervical cancer screening at age 21. Between 21 and 29, a Pap smear should be performed every three years. In this age group, HPV testing should only be used if a Pap smear returns with abnormal cell results.
When a woman turns 30, the Pap smear should be used along with an HPV test. This co-testing should continue at five-year intervals until age 65. For women at higher risk of cervical cancer, screenings need to be performed more frequently. The most important risk factor for cervical cancer is the presence of human papilomavirus, which is actually a group of more than 150 related viruses. Certain types of HPV, sometimes referred to as high-risk, have been strongly linked to cervical cancer.
Additional risk factors for cervical cancer include smoking, having a weakened immune system due to HIV or taking immunosuppressive drugs, being infected with chlamydia, a family history of cervical cancer, and exposure to DES, a hormonal drug given to some women between 1940 and 1971. If any of these risk factors apply to you, talk to your physician or gynecologist about whether you should increase the frequency of screening.
At age 62, you’re on track for at least one more round of co-testing with both a Pap smear and an HPV test. At age 65, the guidelines change again. Women 65 and older who have had regular screenings for the previous 10 years, and whose tests have not turned up any abnormalities in the previous 20 years, can stop Pap smears.
As for pelvic exams, that’s another nexus of change. The U.S. Preventive Services Task Force has recently declined to say that pelvic exams are necessary. Pelvic exams may have diagnostic value for detecting conditions like genital herpes, ovarian cysts, uterine fibroids, genital warts and others. We recommend that you discuss your options with your gynecologist or primary care physician.
Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.