Screening of Cervical Cancer

Executive Summary

Screening of cervical cancer identifies the changes in cervix cells resulting in cancer. Cervical cancer screening involves cervical cytology (also known as Pap test) and human papillomavirus (HPV) testing. Usually, 37 years is the tentative period for cervical cells to become cancerous with high-grade modifications. Women having low-grade changes can be tested frequently to check if their cells go back to normal. The screening tests for cervical cancer involve the Pap test and HPV test. Visual inspection with acetic acid (VIA) is a screening test done using tools and the naked eye. The frequency of screening tests includes the age and health history of the patient.

The cervical cancer screening tests are stopped after 65 years of age if the patient has either two negative co-tests in the past ten years and three negative Pap test results in recent three years and does not have a history of moderate or severe abnormal cervical cancer. Decisions regarding cervical cancer screening are becoming more specific as per the individual’s health condition.

Screening for Cervical Cancer

Cervical cancer screening detects changes in the cervix cells that could lead to cancer. Screening consists of cervical cytology (also called the Pap test or Pap smear) and, for some women, testing for human papillomavirus (HPV) ​1​.

It usually takes 37 years for high-grade modifications in cervical cells to become cancerous. Cervical Cancer screening may detect these changes even before they become cancer. Women having low-grade changes can be tested frequently to check if their cells go back to normal. Women with high-grade changes can have treatment to have the cells removed.

Screening tests can provide help in preventing Cervical Cancer or finding it earlier – 

  • The Pap test looks for precancers and cell changes on the cervix that might become Cervical Cancer if not treated appropriately. A Pap test involves accumulating a sample of cells from the cervix. It is often done simultaneously as a bimanual pelvic exam and a gynecologic checkup. A Pap test can be combined with an HPV test.
  • The HPV test looks for the HPV that can cause these cell changes. Both these tests are performed in a doctor’s office or clinic ​2​. The doctor uses a plastic or metal instrument called a speculum during the Pap test to widen your vagina. It usually helps the doctor examine the vagina and the cervix and collect a few cells and mucus from the cervix and its area. These cells are sent to a laboratory for Cervical cancer deduction.

If you take a Pap test, the cells are checked to see if they appear normal.

If you take an HPV test, the cells will be tested for HPV.

Visual inspection with acetic acid (VIA) is a screening test that can be done using tools and the naked eye. During VIA, a white vinegar dilution is applied to the cervix. The abnormalities on the cervix will turn white when exposed to vinegar. This screening test for Cervical cancer is beneficial in places where access to medical care is limited.

How often should I have screened, and which tests should I have?

It depended on your age and health history:

  • Women between the age of 25 to 65 should receive an HPV test once every five years.
  • Women aged 21 to 29 should have a Pap test alone every three years. HPV testing is not recommended.
  • Women 65 and older or women who have had a hysterectomy can stop screening if their HPV test results have been negative over the last 15 years.
  • Women aged 30 to 65 should have a Pap test and an HPV test (co-testing) every five years. It also is acceptable to have a Pap test alone every three years.

When should I stop having Cervical cancer screening?

You can stop Cervical Cancer screening after the age of 65 years if ​3​:

  • You have had two negative co-test results within the past ten years or three negative Pap test results in a row, with the most recent test performed within the past five years.
  • you don’t have a history of moderate or severe abnormal cervical cancer

Decisions regarding cervical cancer screening are becoming more individualized. Sometimes, screening can differ from the recommendations discussed above due to various factors. Such factors include your risk factors and your health history.

References

  1. 1.
    Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sexual Medicine Reviews. Published online January 2020:28-37. doi:10.1016/j.sxmr.2019.09.005
  2. 2.
    Yuan Y, Cai X, Shen F, Ma F. HPV post-infection microenvironment and cervical cancer. Cancer Letters. Published online January 2021:243-254. doi:10.1016/j.canlet.2020.10.034
  3. 3.
    Adler DH, Wallace M, Bennie T, et al. Cervical Dysplasia and High-Risk Human Papillomavirus Infections among HIV-Infected and HIV-Uninfected Adolescent Females in South Africa. Infectious Diseases in Obstetrics and Gynecology. Published online 2014:1-6. doi:10.1155/2014/498048