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JAMA Patient Page
December 3, 2014

Screening for Cervical Cancer

JAMA. 2014;312(21):2302. doi:10.1001/jama.2014.16296

Screening for cervical cancer is done by Pap smears and HPV testing.

Why Test for Cervical Cancer?

The cervix is the bottom part of the uterus (the womb). Often, cervical cancer in its early stages causes no symptoms. Therefore, the best way to find early cervical cancer is to test all women in a certain age group, even if they have no symptoms. This is known as cervical cancer screening. Screening tests for cervical cancer can find not only early cancers but also abnormal, precancerous cells that have a high chance of turning into cancer. Cervical cancer or precancer treated at an early stage can usually be cured.

Tests Used for Cervical Cancer Screening

There are 2 tests that can be used for cervical cancer screening: a Papanicolaou (Pap) smear and a human papillomavirus (HPV) test. One or both of these tests is recommended depending on a woman’s age and medical history.

A Pap smear is done by using a speculum (a device that looks like a duck beak) to keep the walls of the vagina open, and using a small brush or spatula to collect some cells from the cervix. This is a quick procedure done in a doctor’s office. The cervical cells are then looked at under a microscope to identify cancer or precancerous cells.

An HPV test is also done using a sample of cells from the cervix. These cells can be analyzed to look for the HPV virus, which can infect cervical cells and cause cervical cancer in some women.

Who Should Be Screened for Cervical Cancer?

In 2012, the US Preventive Services Task Force and the American College of Obstetricians and Gynecologists (ACOG) released updated recommendations on who should be tested for cervical cancer and what types of tests should be done. These recommendations replaced older ones that stated that women should be tested every year—this is no longer the case.

In the December 3, 2014, issue of JAMA, a JAMA Clinical Guidelines Synopsis article discusses the ACOG guideline on cervical cancer screening. A summary of the recommendations is below.

Who Should Get a Pap Smear and How Often?

  • All women should have their first Pap smear at age 21 years. Screening before age 21 years is not recommended, even for women younger than 21 who are sexually active.

  • If the results are normal, Pap smears should be done every 3 years until age 30 years.

  • After age 30 years, women can continue to have Pap smears every 3 years or they can have a Pap smear with HPV testing every 5 years.

  • Women can stop having Pap smears at age 65 years if they have had routine screenings with normal results for the prior 10 years.

Women who have abnormal Pap smear results may need either further testing (such as a biopsy of the cervix) or a follow-up Pap smear sooner than 3 years.

Who Should Get an HPV Test and How Often?

  • Testing for HPV is not recommended for women younger than 30 years.

  • After age 30 years, women can have an HPV test along with a Pap smear every 5 years.

  • Women can stop having HPV tests at age 65 years if they have had routine screening with normal results for the prior 10 years.

These recommendations are the same for women who have and who have not received the HPV vaccine.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: Volerman A, Cifu AS. Cervical cancer screening. JAMA. doi: 10.1001/jama.2014.14992.

Topic: Preventive Medicine

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