Forget one-size-fits-all advice: Guidelines out Wednesday give women choices for cervical cancer testing that depend on their age.
Once recommended every year, many major medical groups have long said that a Pap test every three years is the best way to screen most women, starting at age 21 and ending at 65. But starting at age 30, you could choose to be tested for the cancer-causing HPV virus along with your Pap—and get checked every five years instead, say separate guidelines issued by the U.S. Preventive Services Task Force, the American Cancer Society and some other organizations. It’s not a requirement —women 30 and over could stick with the every-three-years Pap and do fine, the guidelines say.
But if they choose the newer Pap-plus-HPV option and the results of both tests are negative, the guidelines conclude it’s safe to wait a bit longer than previously recommended for the next cervical check. That’s because certain strains of HPV, the human papillomavirus, cause most cervical cancer, but the infection has to persist for a number of years to do its damage.
The cancer society already said women 30 and older could use both tests, but draft recommendations issued last fall by the task force, which advises the government, didn’t include that option. The task force has since reviewed additional evidence and rewrote its final guidelines so that the medical groups now agree. The question is whether doctors will follow the recommendations. Already, studies have shown that too many doctors are giving younger women routine HPV tests, contrary to long-standing advice. Even patients have wondered if it’s really OK not to get a yearly screening. It is, and better understanding of how cervical cancer grows makes that clear, Dr. Jeffrey Peipert, a gynecologist at Washington University in St. Louis, wrote in an editorial in Annals of Internal Medicine assessing the guidelines. “More frequent screening than recommended not only offers no benefit, but it can cause harm,” Peipert wrote. He concluded: “We should embrace the guidelines.” Cervical cancer grows so slowly that regular Pap smears -— which examine cells scraped from the cervix —- can find signs early enough to treat before a tumor even forms. Today, about half of all cervical cancer is diagnosed in women who’ve never been screened, or have gone many years between checks, Peipert noted. HPV tests can add an extra layer of information, if they’re used correctly. Routine HPV screening is not for women younger than 30, the guidelines stress. HPV is a super-common virus in younger women and their bodies usually clear the infection on their own.
The advice for younger women has long been to get HPV testing only if a Pap signals a possible problem. A Pap averages around $40; HPV tests can add another $50 to $100. The new guidelines are aimed at otherwise healthy women, not those at high risk of cervical cancer. They also say:
—A stand-alone HPV test, without a Pap, isn’t recommended.
—Women over 65 can end screening if they have had several negative tests in a row over a certain time period. But women in that age group who have a history of pre-cancer should continue routine screening for at least 20 years.
—The cancer society says women who have gotten a new vaccine against HPV still need routine screening.