Highland Women's Care

Cervical Cancer Screening: Start to Finish 

            There are several questions commonly asked by women during annual gynecological exams.  Two of the most common asked are, “What is a pap test looking for?” and “When should my daughter start annual exams and pap tests?” 

            I am always surprised by the first question.  Many women are faithfully getting annual examinations and pap tests but are unsure why they are getting them. A pap test screens for cervical cancer.  The cervix is the bottom segment of the uterus that dilates open when a woman has a baby. Inside the cervical canal is where squamous cells from the cervix and columnar cells from the uterus meet.  This delicate area, called the squamous-columnar junction, is where cervical cancers most often arise. 

            The incidence and death rates from cervical cancer in the U.S. have dropped almost 50% since the widespread use of pap tests beginning in the early 1970’s, however, cervical cancer remains the third most common gynecological cancer  in the U.S. The current recommendation by ACOG (American College of Obstetricians and Gynecologists) for having the first screening of cervical cells should begin approximately three years after a young woman’s first sexual intercourse or by age 21, whichever comes first.    

            Women up to age 30 should undergo annual cervical cancer screening because women under 30 have a higher likelihood than older women of acquiring high-risk virus types that can cause pre-cancerous cervical diseases.  Pre-cancerous cervical disease should be ruled out before extending the testing intervals.  In addition, please remember that even if a woman has had the HPV vaccine, she is not protected against all cervical cancers, only approximately 70 percent of those cancers caused by Human Papillomavirus.  It is still recommended at this time that these women continue to be screened.

            ACOG recommends that women age 30 and older get annual cervical cancer screenings until three consecutive negative pap smears have been obtained.  At that point, some health care providers may recommend that women only need to be re-screened with pap tests every 2-3 years but have gynecological examinations yearly.  This plan must be individualized for each woman by her health care provider based upon her risk factors for cervical cancer.  Women at higher risk for cervical cancer, including women who are infected with HIV, have suppressed immune systems, have more than one sexual partner, or women with a history of cervical cancer, will need more frequent cervical screening and should get a yearly pap.

            Many women who have had a hysterectomy with removal of the cervix incorrectly assume that if they do not have a cervix, there is no need for annual examinations or pap tests.  ACOG recommends that if a hysterectomy was performed for benign (non-cancer) reasons and the woman has no history of abnormal or cancerous cervical cell growth, she may discontinue routine pap tests.  However, women who have had a hysterectomy but have a history of abnormal cervical cells should be screened annually until they have three consecutive, negative vaginal cytology tests.  At that point, routine screening may become less frequent, and some health care professionals may suggest discontinuing screening completely.  However, some healthcare providers may recommend continued intermittent screening due to the small increased risk of vaginal/vulvar cancers as women age, and/or if she has more than one sexual partner. 

 Finally, the American Cancer Society suggests that low risk women stop cervical cancer screening at age 70 but ACOG notes that due to limited studies of older women, it is difficult to set an across-the-board upper age limit for screening but it is still recommended that annual gynecological examinations be performed.  Regardless of the frequency of cervical cancer screening, annual gynecologic examinations, including pelvic and breast examinations are always recommended.   It is vital that each woman make an individualized plan with her health care provider based on her history and risks for cervical or vaginal cancers.  Please discuss any concerns or questions regarding cervical cancer screening with your healthcare provider.  Together, we can continue to increase cervical cancer and cervical cancer screening awareness!

Sara Smith is a Certified Women’s Health Nurse Practitioner. Appointments can be made with Sara Smith at Highland Women’s Care, 815-233-0999.