Doctor's Blog

December, 2009

Cervical cancer screening

The incidence of cervical cancer has decreased by 50% over the last 30 years due to routine pap screening. Still, there were 11,270 new cases of cervical cancer in the US in 2009 per the American Cancer Society.

Cervical cancer is caused by human papillomavirus (HPV) which is most commonly spread during sexual intercourse. Cigarette smoking and a compromised immune system may play a role in acquiring the infection. HPV occurs most commonly in teenagers and women in their early 20s. This age group is most likely to have spontaneous resolution of the infection. Older women with abnormal pap smears can have persistent infections that are more likely to progress to high-grade lesions. Thus, HPV DNA testing can be done with routine pap screening in women over 30 years old.

Women age 18-22 have a 91% chance spontaneous resolution of HPV infection within 3 years. Thus cervical cancer screening guidelines have changed to begin screening at age 21. Women age 21-29 should have pap smears every 2 years. After 3 negative consecutive pap smears, women greater than age 30 can decrease screening to every 3 years.

Women at high risk for cervical cancer require yearly screening. This group includes:

• HIV
• Immunocompromised individuals
• DES exposure in utero
• History of abnormal pap smear with HSIL (high-grade squamous intraepithelial lesion)
• Previous history of cervical cancer

Women aged 65 and older represent 14.3% of the US population, but have 19.5% of new cases of cervical cancer. Postmenopausal women with multiple consecutive normal pap smears are at low risk. Cervical atrophy predisposes to a higher false positive rate which can then lead to unnecessary procedures. The American Cancer Society recommends stopping cervical screening at age 70, but the US Preventive Services Task Force recommends stopping at age 65.

Women, who have no history of abnormal pap smears and have had a total hysterectomy secondary to a benign cause such as uterine fibroids, can discontinue routine pap screening. If the hysterectomy was due to an abnormal pap with a high-grade lesion, pap screening should continue yearly.

Please see your primary care provider to discuss your risk factors for cervical cancer screening.  

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