As health care providers, you are probably aware that cervical cancer screening guidelines have changed significantly in recent years. The goal of cervical cancer screening is to prevent morbidity and mortality. It's important that we as health care providers clearly communicate with our patients about when cervical screening is needed and what testing is best for them, based on their age and individual medical history.
Since its introduction more than 50 years ago, the Pap test has successfully prevented more than 75 percent of cervical cancers. Greater understanding of HPV and its role as the causative agent in cervical cancer has led to significant changes in how we screen women to prevent this cancer. We can now use HPV vaccination to prevent infection by cancer-causing (high-risk) HPV in young women. And we can improve screening in women 30 and older with the addition of HPV testing along with the Pap test.
New screening guidelines recommend women get their first Pap test at age 21 and every three years after that. Women 30 and older may have a Pap every three years, but the preferred screening is that they undergo co-testing with a Pap and an HPV test every five years. Women may stop screening at age 65 if they have a history of adequate and normal screening in the previous 10 years.
An optimal screening strategy should1:
- Identify those cancer precursors likely to progress
- Avoid unnecessary treatment of transient human papillomavirus (HPV) infections and benign lesions
- Co-testing using the Pap and HPV tests has potential to increase disease detection
- Longer screening intervals means less harm
- Psychosocial impact of positive screening test
- Additional visits and procedures
- Treatment of lesions destined to resolve
The evidence-based guidelines are available as online documents, pocket guides and phone apps.2
Women have come to expect a Pap test every year, and the Pap has come to define the annual well-woman visit. We need to teach every woman about the benefits of cervical screening and expanded screening of women 30 and older by Pap and HPV. But it is also important to reassure women about the safety of getting fewer Pap tests and waiting five years before repeating co-testing.
The negative predictive value of a negative HPV test along with the negative Pap allows for safely widening the screening interval. We need to discuss HPV, vaccination, the meaning of the Pap and HPV test and the importance of continued well-woman visits in the era of decreased cervical screening, with all women.
Nancy R. Berman, ANP-BC, NCMP, is an adult nurse practitioner, currently specializing in women's health care at The Millennium Medical Group, PC, a division of Michigan Healthcare Professionals, in Southfield, Michigan. She is a clinical instructor in the Department of Obstetrics and Gynecology, School of Medicine at Wayne State University in Detroit, Michigan.
References:
1. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Journal of Lower Genital Tract Disease. 2012;6(3):175-204.
2. American Society for Colposcopy & Cervical Pathology. www.asccp.org. Accessed December 9, 2013.
