Doctors routinely advise that women undergoing screening for cervical cancer receive Pap smears every three years beginning at age 21. Now, beginning at 30, women have a new option.
Instead of undergoing a pelvic exam, these patients may go to a doctor’s office and collect their own vaginal sample to be tested for human papillomavirus, the infection that causes most cases of cervical cancer, according to new guidelines issued on Tuesday by a national health services panel.
Self-collection of the sample was approved in May by the Food and Drug Administration. The HPV test should be repeated every five years from age 30 until 65, when most women can stop screening, the U.S. Preventive Services Task Force said.
Other screening options for those 30 and older include continuing with Pap tests every three years, or a combined Pap smear and HPV test every five years, the task force said. But an HPV test every five years is the ideal screening method, providing the best balance of risks to benefits.
The new recommendations apply to women and anyone who was assigned female at birth and still has a cervix, regardless of whether they have been vaccinated against HPV.
The advice was issued amid growing concern about a falloff in cancer screenings, and confusion resulting from changes over time in screening regimens and tests used for early detection and prevention of cervical cancer.
Use of self-collected vaginal swabs for HPV tests is being recommended for the first time in the guidelines, partly in an effort to increase screening and make it easier.
“It’s important to emphasize that cervical cancer is one of the most treatable and preventable types of cancer,” because screening is so effective, said Dr. John Wong, vice chair of the task force.
Cervical cancer tends to be slow-growing, he explained. Pap smears can pick up precancerous changes, while HPV tests pick up persistent infections that don’t resolve on their own and may trigger cancerous cellular changes over time.
Most women who develop cervical cancer are those who have not been getting regular screening, experts say. About one-quarter of women aged 21 to 65 were not up-to-date on their cervical cancer screenings in 2021, according to the Centers for Disease Control and Prevention.
Asian American women and Hispanic women were more likely to be overdue for screenings than white or Black women, according to National Health Interview surveys.
Cervical cancer was once among the top cancer killers of American women, but both rates of the cancer and deaths caused by it have plunged by more than 70 percent since the Pap test was introduced.
The disease still kills 350,000 women annually around the globe, and it is the leading cause of cancer death for women in 37 countries, most of them in sub-Saharan Africa and Central and South America, where screening is not easily available.
In the United States, however, incidence fell in the last five decades to 6.8 cases per 100,000 women per year in 2022 from 13.9 cases per 100,000 women each year in 1975, while deaths declined to 2.2 per 100,000 women from 5.5 per 100,000, according to the National Cancer Institute. Early detection and prevention through the use of Pap smears precipitated much of the decline.
But recent changes in screening guidelines have left not only many patients confused, but also some providers, said Dr. Karen Lu, executive vice president and physician in chief of Moffitt Cancer Center in Tampa, Fla.
“You can get so much in the weeds that you forget about the big picture,” which is that cervical cancer is preventable and curable when caught early, Dr. Lu said.
“What we worry about, as doctors who take care of women with cervical cancer, is that if screening becomes less routine, people kind of forget to do it.”
And just because cervical cancer screening needs to be done only every five years after age 30 does not mean that other gynecological care can be skipped, Dr. Lu said.
“People equate a pelvic exam with a Pap smear, but that’s absolutely not true,” she said. “Examination of the cervix and uterus, especially in the 40s and 50s when your risk for endometrial and ovarian cancer starts to pick up, should still be done.”
This year, the American Cancer Society estimates that 13,820 new cases of invasive cervical cancer will be diagnosed and that about 4,360 women will die of it.
The society’s screening recommendations are slightly different from those issued by the task force: It recommends starting screening at age 25 with an HPV test, and undergoing that test every five years.
If the HPV test is not available, the society recommends “co-testing” every five years — a combined Pap smear and HPV test — or having a Pap smear every three years.
The American Cancer Society guidelines emphasize that “the most important thing to remember is to get screened regularly, no matter which test you get.”
A positive or abnormal HPV test or Pap smear should be followed up with repeat tests and, if necessary, follow-up procedures depending on the findings, Dr. Wong said.
Women can stop screening at age 65 as long as they have had a history of normal test results from the past three Pap smears or their last two HPV tests — so long as those were done within the past 10 years, and at least one was done within the past five years.
(Women who have had their cervix removed as part of a total hysterectomy also do not need to be screened.)
Older women should continue screening past age 65 if they have not been getting screenings on a regular basis, or have had abnormal results in the past 10 years.
None of these recommendations apply to women who are at increased risk of cervical cancer and need extra monitoring, including women with H.I.V. or compromised immune systems, women who were exposed prenatally to diethylstilbestrol, and anyone who had cervical cancer or was treated for precancerous lesions in the past.
The new task force guidelines are a draft recommendation, but there is usually little change between the draft and the final version of the guidelines.
