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Screening for Cervical Cancer
The US Preventive Services Task Force (USPSTF) has recently published updated recommendations
on screening for cervical cancer.
What Is Cervical Cancer?
The cervix is the bottom part of the uterus (womb) in women. The
main symptom of cervical cancer is abnormal vaginal bleeding; how-
ever, very often, cervical cancer in its early stages causes no symp-
toms. This is why screening is important. Cervical cancer or precan-
cer treated at an early stage can usually be cured. Treatment options
include surgery, radiation therapy, and chemotherapy.
What Tests Are Used to Screen for Cervical Cancer?
Two tests can be used for cervical cancer screening: a Papanicolaou
(Pap) test 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 test is done using a speculum (a device that looks like a
duck bill) to keep the walls of the vagina open and a small brush
or spatula to collect 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 abnormal precancerous cells.
An HPV test is also done using a sample of cells from the cer-
vix. These cells are analyzed to look for the HPV virus, particularly
high-risk HPV strains, which can infect cervical cells and cause cer-
vical cancer in some women.
What Is the Patient Population Under Consideration
for Screening for Cervical Cancer?
This USPSTF recommendation applies to women who do not have
symptoms of cervical cancer and do not already have a diagnosis of
precancerous cervical cells. The recommendation does not apply to
women with in utero exposure to diethylstilbestrol (an estrogen
medication that is mostly no longer used) or women who have a com-
promised immune system (for example, women living with human
immunodeficiency virus infection).
What Are the Potential Benefits and Harms of Screening
for Cervical Cancer?
The goal of screening for cervical cancer is to catch cervical cancer
(or precancer) early; these cases are more treatable and curable
than advanced cancer. There is good evidence that the Pap and
HPV tests are good at finding cancer and precancerous cells. There
is also good evidence that using these screening tests results in
decreased rates of and deaths due to cervical cancer in women
aged 21 to 65 years. Potential harms of screening involve additional
testing, which can be more invasive (eg, biopsy of the cervix).
In the case of a false-positive result or overdiagnosis (finding a can-
Author: Jill Jin, MD, MPH
Correction: This article was corrected on August 27, 2018, for an omission in the
illustration.
Source: US Preventive Services Task Force. Screening for cervical cancer: US
Preventive Services Task Force recommendation statement [published August 21,
2018]. JAMA. doi:10.1001/jama.2018.10897
732 JAMA August 21, 2018 Volume 320, Number 7 (Reprinted)
© 2018 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ on 11/04/2019
cer or precancer that never would have caused any health prob-
lems), unnecessary treatment may also have negative side effects.
There may also be some psychological harm from a diagnosis of
HPV infection. However, for most women, the overall magnitude
of harm is small compared with the magnitude of benefit.
How Strong Is the Recommendation to Screen
for Cervical Cancer?
The USPSTF concludes with high certainty that the benefits of
screening for cervical cancer substantially outweigh the harms in
women aged 21 to 65 years. The USPSTF concludes with moderate
certainty that the benefits of screening do not outweigh the harms
in women older than 65 years who have had routine prior screen-
ing. The USPSTF concludes with moderate certainty that the harms
of screening outweigh the benefits in women younger than 21 years
of age. The USPSTF concludes with high certainty that the harms of
screening outweigh the benefits in women who have had their uterus
and cervix removed for reasons other than cancer.
Screening for Cervical Cancer
Population
Women who do not have symptoms of cervical cancer
and do not already have a diagnosis of precancerous
cervical cells or a weakened immune system
USPSTF recommendation
Cervical cancer screening is recommended in women
aged 21 to 65 years. For women aged 21 to 30,
screening should be done by a Pap test every 3 years.
For women aged 30 to 65, screening can be done by a Pap
test every 3 years, a high-risk HPV test every 5 years, or a
Pap test plus a high-risk HPV test every 5 years.
Screening should not be done in women younger than 21
years, older than 65 years (if they have had routine prior
screening with negative results), or who have had their
uterus and cervix removed.
FOR MORE INFORMATION
US Preventive Services Task Force
www.uspreventiveservicestaskforce.org/Page/Document
/UpdateSummaryFinal/cervical-cancer-screening2
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