An NCI-designated Comprehensive Cancer Center
By Veronique de Turenne | January 11, 2016

Get screened for HPV.

That’s the message from experts working to reduce the number of cervical cancer cases. Cervical cancer begins with a cancer-associated strain of the human papillomavirus, or HPV. But that infection is only a first step in the development of the disease. Lack of screening for the virus and for the early stages of cervical cancer contributes as well.

Screening tests such as the pap smear have helped to decrease the incidence of cervical cancer and are a primary focus of efforts to further fight the disease. In fact, most cases of cervical cancer are seen in women who were never screened or received inadequate testing, said Ernest Han, M.D., Ph.D., an assistant professor in the Division of Gynecologic Oncology in City of Hope’s Department of Surgery.

Revised screening guidelines

In 2012, health experts revised cervical screening guidelines to include HPV testing in combination with the pap smear, known as co-testing. In January of this year, the American College of Obstetricians and Gynecologists (ACOG) updated those guidelines further. The guidelines now include the option to use a recently Food and Drug Administration (FDA)-approved HPV primary screening test alone for screening cervical cancer in women 25 years and older.

“Over 99 percent of cervical cancer cases are related to HPV,” Han said. “Other factors, such as smoking, HIV infection and the condition of a woman’s immune system can also play a role.”

Doctors diagnose about 12,900 cases of cervical cancer each year. In its early stages, the disease often may not lead to symptoms. Advanced cervical cancer can cause abnormal vaginal bleeding, vaginal discharge, pain in the lower back or pelvis, or bleeding from the rectum or urinary tract.

Thanks to widespread screening in the US, the number of cervical cancer cases have dropped by 50 percent in the last 30 years. Today, cervical cancer development may be preventable, especially with the recent introduction of HPV vaccination for boys and girls aged 9 to 26 years.

“Screening guidelines change as data from clinical trials research becomes available,” Han said. Existing information is reassessed and our clinical practices are redefined over time.”

The ACOG guidelines for cervical cancer screening currently recommend the following:

  • Women should begin cervical cancer screenings at age 21.

“Finding cervical cancer in women under 21 is exceptionally rare,” Han said. “Screening a lot of women to find that very rare case is not helpful and may lead to problems in terms of overtesting and overtreatment.”

  • A Pap test is recommended for women between 21 and 29.

In this age group pap smear testing every three years is recommended. Because HPV is very common in young women, and since most cases clear up on their own, screening guidelines do not recommend HPV co-testing in this age group, Han said. Women in this age group with an abnormal Pap result will then need to receive the appropriate follow-up testing with their doctors.

However, according to the new ACOG guidelines, patients and doctors can consider a FDA-approved primary HPV test as an alternative to the Pap test in women 25 years and older, Han said.

  • From ages 30 to 65, women should have both a Pap and HPV co-testing every five years (preferred), or a Pap test alone every three years (acceptable).
  • “For women 30 and over the HPV test is significant,” Han said. “HPV infection in women 30 and older can signal a persistent infection, which may lead to development of precancerous changes to the cervix.”

Remain vigilant

Although continued adjustments to screening recommendations reflect the latest research, they can also be difficult to understand for some patients, Han said. “Some women are just used to getting their pap smears every year,” according to Han. Patients sometimes get uncomfortable with the thought of less screening. Also, some doctors are also reluctant to change their practice pattern for fear of patients not coming back to the office for their annual well woman check-ups. The most important thing is that women remain vigilant about regular cervical cancer screenings.

Patients often may ask if pap smear screening is necessary after a certain age. Currently, women over 65 years or who underwent a total hysterectomy do not require screening unless they had a prior history of precancerous changes to the cervix. It is important to inquire with your physician before considering to stop screening.

“The women we do see cervical cancer in are those who did not get screened adequately,” Han said. “Ask them when their last screening was and they’ll say it was more than five years ago, and that can be a big problem for some patients.”


Learn more about City of Hope's cervical cancer program and research. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

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