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New Guidelines for Cervical Cancer Screening

Women over 65 may not need screening while younger women have a new option

Mature African American woman sitting on the exam table in a doctor's office. She looks concerned.

Jose Luis Pelaez, Getty Images

En español | New cervical cancer screening guidelines announced this week by the influential U.S. Preventive Services Task Force give women over 30 more choice when it comes to getting their regular Pap smear (or not getting it.)

While guidelines from the task force, the body that insurers tend to follow when deciding which procedures they are likely to cover, don’t rule out continuing to get a Pap smear if you’re between 30 and 65, it’s now one of three options. The shift, experts say, may herald a phasing out of the test that’s brought down cervical cancer mortality rates by 80 percent since its introduction in the 1950s.

Now, if you’re between 30 and 65, you could opt either for a Pap smear every three years or to just get an HPV test — still taken by swab, but a different type of test — every five years. It detects the presence of the human papillomavirus, which causes 99 percent of cervical cancer cases; the Pap smear detects the presence of abnormal cells that can indicate cervical cancer or the danger of developing it. Or you can ask for a hybrid test. (Women between 21 and 29 should have a Pap smear every three years. That isn't changing.)

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If this newer screening method and its longer window sound good to you and your doctor, know you’re well covered, says Anna Beavis, M.D., of the Department of Gynecology and Obstetrics, Johns Hopkins Medicine. She notes that medical advisory groups like the Society of Gynecologic Oncology (SGO) and American College of Obstetricians and Gynecologists (ACOG) had already issued guidance that HPV screening by itself would be reasonable. Also, she says, the new recommendations are based on “randomized controlled trials showing that you pick up just as many cases [of cervical cancer] with HPV alone, and you avoid doing unnecessary procedures for false positives.”  

As for the advice to stop with any kind of screening at age 65? The guidelines mostly confirm that. However, says Beavis, “the recommendations state that there were no new screening studies in women over the age of 65, and that future research may be warranted to examine the potential harms versus benefit — basically a balance of the likelihood a woman will be diagnosed with cervix cancer compared to the harms associated with the follow-up testing of an abnormal Pap smear.” What’s more, if you’ve missed a Pap smear in the past few years, you're not off the hook. As Beavis explains, “The newest U.S. Preventive Services Task Force recommendations do not recommend screening past age 65 for women who have been adequately screened in the 10 years prior to age 65.” They also don’t apply to women who’ve had things like high-risk cervical precancer diagnoses.

If you’re confused, know that doctors are less so: Now that the medical groups’ guidelines are all in agreement, there will be less confusion about what options are available for women, Beavis says. And whatever type of screening you get, staying on schedule with it will greatly reduce your chances of getting cervical cancer. Encouraging your daughter or granddaughter to get the HPV vaccine — which is given only up to age 26 — will reduce her chances of ever facing the disease.