Updated cervical cancer screening guidelines.  Do you really need that pap?

Why test for cervical cancer?  4000 patients still die annually from cervical cancer.  This is dramatically decreased compared to the 1950s, but racial and socioeconomic disparities continue to contribute to this number as our undocumented and uninsured may not have routine preventive care.

What is the best screening test? In 2018 the US Preventive Services Task Force (USPSTF) recommended testing for human papillomavirus WITHOUT cytology (meaning without a pap) as an option for cervical cancer screening for women 25 years and older.   Despite this recommendation, physicians often still perform a pap with HPV testing every 3 to 5 years, depending on the woman’s age.

What about women who have had the HPV vaccines?  In vaccinated patients, abnormal pap results are usually caused by HPV types with a low cancer risk.  The HPV vaccines are meant to vaccinate against the subtypes of HPV that are known to cause cells on the cervix to change from normal cells to cancerous ones.

When to stop doing paps?  If a patient has had a normal pap smear before, women can stop having paps at age 65.  Testing beyond age 65 in previously screened patients adds little benefit or life expectancy.  If the woman had been diagnosed with grade 2 or greater cervical dysplasia within the past 25 years and has had a normal pap within the past 10 years, she too does not need another pap after age 65.

I urge that you see your physician yearly for a well adult visit and you two can have a conversation about which test would be best for you.