Healthy Living is a weekly television news segment seen on WABI-TV5. Local physicians from Eastern Maine Medical Center and The Acadia Hospital give opinions on the latest research, highlight concerns, and eliminate fear. They focus on important health issues that concern you and your family.Watch the segment each Tuesday on Channel 5's First News at five!.
New Guidelines for Cervical Cancer Screening
Healthy Living - March 24, 2015
Garrick Slate, MD
Many women (and some providers) have not been introduced to the 2012 guidelines as recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP), the United States Preventative Services Task Force (USPTF) and adopted by the American Congress of Obstetricians and Gynecologists (ACOG).
Why did the guidelines change?
Studies over the past decade have found that there is NO overall advantage to having yearly PAP tests over PAP tests every 3 years.
While yearly PAP tests DO find a slightly higher number of cervical cancer cases than PAPs done every 3 years they subject many patients to follow-up tests and procedures that can be unnecessary, painful and anxiety-provoking.
Most cervical cancer occurs in women who were either never screened or inadequately screened. 50% of women who develop cervical cancer never had cervical cytology (PAP) screening and another 10% have not had screening within 5 years.
Improving public health measures and access to women who are uninsured or underinsured is important to decrease these percentages. Immigrant women and women lacking a regular source of health care are at especially high risk.
Most cases of cervical cancer are caused by the Human Papilloma Virus (HPV)
HPV is the most common sexually transmitted virus.
HPV can be divided into Cancer-causing (oncogenic) and Non-cancer-causing (non-oncogenic)
The HPV types are given numbers and HPV 16 and 18 are responsible for approximately 80% of all cases of cervical cancer.
Women who smoke; are immunosuppressed and HIV-infected individuals are especially at risk.
HPV is considered transient in women under 21 years of age and most women 21 and under completely clear the infection within 8-24 months.
Cervical screening methods:
Cytology – looking at the cervical cells under a microscope for abnormalities
HPV-DNA “PAP Co-test” – looking for HPV DNA within the cervical cells
Start screening by cytology only “PAP” at 21 years of age – not before
Women aged 21-29 should have a PAP EVERY 3 years.
Women aged 30-65 should have a PAP with HPV DNA testing every 5 years
Cytology alone every 3 years is still acceptable but not preferred
STOP PAP testing after age 65
For women who have had hysterectomy for non-cancer indications with no history of moderate or severe cervical disease.
Women with a history of moderate or severe disease (dysplasia) will need continued surveillance for a period of time – see your health care provider
Exceptions to the New Guidelines:
Women with history of cervical cancer, HIV or a weakened immune system, or exposure to DES (Diethylstilbestrol) should not follow the new guidelines
If you have an abnormal cervical cancer screening test result, you may require additional testing or treatment.
An abnormal result RARELY is cervical cancer – it is usually a precancerous change that can be easily treated.
Your health care provider will explain the results and recommend follow-up treatment and explain when you can resume regular cervical “PAP” screenings
All women regardless of insurance or current health care resources are encouraged to discuss their cervical health with a health care provider at EMMC.
Women should still see their healthcare provider every year for well-woman care, preventative health screenings and reproductive health concerns.