In the United States, 12,000 women are diagnosed with cervical cancer each year, even though the screening for this disease is safe and effective. There are 3 types of screening options available: cervical cytology (Papanicolaou or “Pap” test), Pap/HPV (human papillomavirus) co-test, and HPV-only test. With simplified options such as HPV-only screening, providers who have been reluctant to incorporate cervical cancer screening into their primary care practice may feel more comfortable with offering these services to women. In this article we review the different cervical cancer screening options that are now available and summarize the various changes in guidelines over the last decade.
Background
Although cervical cancer screening is effective and safe, almost one-quarter of women aged 45-64 years in the United States have not received timely screening in the prior 3 years.1 Oncogenic “high-risk” human papillomavirus (HPV) subtypes are responsible for nearly all cervical cancers and a variable percentage of anal, vaginal, penile, vulvar, and oropharyngeal cancers.2 The subtypes of HPV 16 and 18 account for 65%-75% of cervical cancers, whereas 12 other high-risk genotypes account for the rest.3 Though immunization (primary prevention) for cervical cancer has the potential to prevent up to 70% of cervical cancers due to HPV,4 screening (secondary prevention) is still a critical strategy for identifying cervical dysplasia and invasive cervical cancer precursors.
Currently, approximately 7% of US women between the ages of 21 and 65 years have never received a screening test in their lifetime, especially foreign-born women who have lived less than 25% of their lifetime in the United States.5 Other under-screened populations include minorities, those with low social–economic status, those with multiple chronic conditions, and those who lack medical access or insurance.1, 6, 7 With simplified options such as HPV-only screening, providers who have been reluctant to incorporate cervical cancer screening into their primary care practice may feel more comfortable with offering these services to women. In this review article, we aim to provide an update on the different cervical cancer screening options that are now available and summarize the various changes in guidelines over the last decade.
Screening Strategies
There are 3 types of screening options available: cervical cytology (Papanicolaou or “Pap” test), Pap/HPV co-test, and HPV-only test (Table). Though there are differences between the 3 strategies, the goal of each recommendation is the same: to identify cervical dysplasia or precancerous lesions in their early stages, before they progress to cervical cancer. We recommend that providers choose the screening strategy that fits best with their practice, because it is most important that women are screened, not how they are screened.
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-Salina Zhang, BS, Megan McNamara, MD, MSc, Pelin Batur, MD
This article originally appeared in the June issue of The American Journal of Medicine.
