Cervical cancer screening

“Cervical cancer is relatively easy to treat if it is caught at an early stage.”

The Society for Gynecologic Oncology

In a 2022 poll of U.S. women ages 18 to 64, 12% of Hispanic women, 8% of Black women and 3% of White women said they have never had an OB/GYN visit for routine care. And 13% of Black women, 12% of Hispanic women, and 6% of White women said they have never had a Pap test.

Source: A November 2022 Harris Poll of 872 U.S. women ages 18 to 64.

“I’m living proof that screening can find cervical cancer when treatment works best”

“When I was 25, I was living in Washington, DC, working as a television producer and loving life. I felt great and healthy, so I put off getting my routine Pap test for a few years. I thought it could wait,” remembers Tamika Felder.

“When I finally did go for a check-up, I got the shock of my life. I had cervical cancer. I was devastated, and I asked myself how this was possible. I was too young and too strong for this.”

Felder eventually had a hysterectomy and underwent chemotherapy and radiation.

“Now I’m cancer-free and enjoying life! I learned just how important it is to have a Pap test regularly. If I hadn’t had that Pap test that led to my cancer diagnosis, I might not be here today. I’m living proof that screening can find cervical cancer at an early stage, when treatment works best.”

In 2005, Felder founded Tamika & Friends, a non-profit, community-based organization dedicated to raising awareness about cervical cancer and human papillomavirus (HPV).

Source: “Tamika’s Cancer Survivor Story” on the CDC website.

"I know it was the routine cervical screenings that changed my life "

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“I was In my late twenties. an entrepreneur running a business, hosting parties every weekend at my bachelorette pad,” says Jasmine.

“As busy as I was, I never let it stop me from keeping up with my regular cervical cancer screenings. My great grandmother, grandmother and aunt all died of cancer. Their deaths motivated me, they helped me commit to staying on top of my doctor’s visits and regular screenings.”

“But then I got the call. The biopsy came back with precancerous cells. It was like all the sound in the world faded out.”

Jasmine worked with her doctor to learn about her treatment options and “a year after I had a procedure to remove pre cancerous cells, I gave birth to my son Isaiah.”

“If I hadn’t found out about the precancerous cells, I may not have the quality of life I have today. In retrospect, I know it was the routine cervical screenings that changed my life.”

A 2-minute video from the Centers for Disease Control and Prevention

"If I had been negligent and not gone for a year or two for screening, I would not be here telling this story"

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“This is very personal…This is very hard for me to talk about…This really, really sucked…I feel like my story can help somebody out there…You don’t want to be in my shoes…I urge women out there to go get Pap smears and my story is going to remind you why you need to do that…Ladies, don’t delay this. Don’t put it off.”

Jani Marti, 26, was reassured for two years that the abnormal cells from her regular Pap tests were nothing to worry about —- until she was suddenly diagnosed with an aggressive form of cervical cancer. She has survived, but she’s mad because she feels her doctor neglected her for a long time and put her through a lot of unnecessary physical and emotional pain and risked her ability to have children.

“The reason I felt it was so important to tell my story is because I’ve sat with other women and other girls my age and talked to them about my problem and they told me, oh, yeah, I’ve had abnormal Paps for three years.

Not okay. It’s not, not okay to have abnormal Paps for three years. It’s not okay if your doctor tells you it’s okay. Bullshit. Go find another doctor. Not okay.”

And if she wasn’t getting screened regularly, “if I had been negligent and not gone for a year or two, I would not be here telling you this story,” Jani says.

Twenty-six year old Jani Marti’s ordeal being diagnosed with cervical cancer.

A 34-minute video.

"Cervical cancer can be prevented. We have the tools to do this: screening, education, and vaccination"

“I am a retired New York City police officer,” says Patti. “Three months before my retirement, I started bleeding between menstrual cycles. At the time, I had not seen a gynecologist in 3 years. Why? Well, my gynecologist had retired, and I didn’t look for a new one. I didn’t feel the dire need to find one since I felt fine. I had no symptoms whatsoever. However, the progressive bleeding, fatigue, and bloating pushed me to go see a doctor.”

A cervical biopsy revealed cervical cancer, stage IIB, and she underwent radiation, chemotherapy, and brachytherapy (internal radiation). Although the therapy was tough and at times she wanted to give up, “I consider myself one of the lucky ones because after treatments, my tumor disappeared and there weren’t any visible cancerous cells. After 9 months, I was cancer-free.”

“My diagnosis has made me a passionate cervical cancer advocate, especially for Hispanic women or Latinas, who have a higher risk for it. Cervical cancer can be prevented. We have the tools to do this: screening, education, and vaccination.

My message to women is that we put ourselves to the side most of the time, and we need to adopt a mindset that ensures that we are making ourselves a priority.”

Source: “Patti’s Cancer Survivor Story” on the CDC website.

“The Tamale Lesson,” an entertaining 12-minute drama about three generations of Latina women discussing cervical cancer screening and the importance, the fear, the embarrassment, and finally overcoming the reluctance about getting screened.

A 12-minute video from the University of Southern California.

In a 2022 poll of U.S. women ages 18 to 64, 12% of Hispanic women, 13% of Black women and 6% of White women said they have never had a Pap test. When asked why they delayed getting a Pap test, Hispanic women were more likely than White women to say they were embarrassed, afraid it would hurt, or didn’t have an OB/GYN.

Source: A November 2022 Harris Poll of 872 U.S. women ages 18 to 64.

Cervical cancer screening

The HPV test and the Pap test can help prevent cervical cancer or find it early.

The HPV test looks for the virus (human papillomavirus) that can cause cell changes on the cervix. The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. Both tests can be done in a doctor’s office or clinic.

Source: “What Should I Know About Screening?” (CDC)

In a 2022 poll, 47% of U.S. women ages 18-64 said they didn’t understand the difference between a Pap test and an HPV test. And 81% of women were unaware of how often someone their age should get a Pap test, while 51% were unaware of how often she should get an HPV test. 

Source: A November 2022 Harris Poll of 872 U.S. women ages 18 to 64.

What happens during a Pap test?

Pap tests, sometimes called Pap smears and named after the inventor, George Nicholas Papanicolaou, are very important tests for finding abnormal cells on your cervix that could lead to cervical cancer.

Pap tests find cell changes caused by HPV, but they don’t detect HPV itself. They may be part of your regular check up, pelvic exam or well-woman exam.

During a Pap test, your doctor or nurse uses a small sampler — a tiny spatula or brush — to gently collect cells from your cervix. The cells are sent to a lab to be tested.

You can get a Pap test at your doctor or nurse’s office, a community health clinic, the health department, or your local Planned Parenthood health center.

Source: “What’s a Pap test?” on the Planned Parenthood website

Lily videoed herself getting a Pap test to show it's not scary

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Lily Taylor was diagnosed with cervical cancer at age 27. She admits she received an abnormal Pap test result six years earlier and foolishly didn’t follow it up.

“At the time, I thought I was invincible and because I was embarrassed, I convinced myself to not go and get another Pap and get checked out.”

Now at age 32, she’s made a video of herself getting a Pap test to show women “that it’s not as scary or embarrassing as you might sometimes think.”

A 3-minute video from Lily Taylor.

Pap test led to sharp decline in cervical cancer deaths

Pap smear cervical cancer Helen Octavia Dickens

The Black Physician Who Popularized the Pap Smear

 

Helen Octavia Dickens, MD,  pioneered the popularity of the Pap smear, helping to save hundreds of lives. The daughter of a former enslaved person who encouraged her to become a nurse, Dickens had other ideas, remembering that “I got it into my head that if I were going to be a nurse, I might as well be a doctor.”

Dickens instigated a program, funded by the National Institute of Health, to carry out Pap tests to detect cervical cancer and was instrumental in spreading the use of the Pap test throughout Pennsylvania. 

For the story of Dickens’ remarkable career and the obstacles she overcame as a pioneering Black female physician, see “The female physician who popularised the Pap smear” by Rachel E Gross on the BBC website (October 12,  2020)

HPV test

Human Papillomavirus or HPV is a virus that can cause changes in cervix cells. The HPV test looks for cervical infection by the high-risk types of HPV that are more likely to cause pre-cancers and cancers of the cervix. The test can be done by itself or at the same time as a Pap test.

Source: “HPV and HPV Testing” (American Cancer Society)

What happens during a HPV test?

An HPV test looks for some high-risk types of the human papilloma virus, including types 16 and 18, which cause most cases of cervical cancer.

During an HPV test, your doctor or nurse then uses a small sampler — a tiny spatula or brush — to gently take a small number of cells from your cervix. The cells are sent to a lab to be tested. An HPV test only takes a few minutes. It shouldn’t hurt, but you might feel some discomfort or pressure.

An HPV test may be part of your regular checkup. Sometimes you’ll get an HPV test at the same time as a Pap test — this is called co-testing.

Source: “What’s an HPV test?” on the Planned Parenthood website.

Which Human Papillomaviruses does HPV testing look for?

There are more than 100 human papillomaviruses. By convention, “HPV testing” refers to the clinical testing for either 13 or 14 of the high-risk HPV types that account for nearly all cervical cancers.

Some HPV tests provide “genotyping.” This refers to testing that specifically identifies HPVs 16 and 18, whereas the other high-risk HPVs are detected within a pooled group. HPVs 16 and 18 are considerably more cancer-causing than the others.

It is widely accepted that testing for low-risk HPV types (types 6 and 11) has no value in clinical practice and is strongly discouraged.

Source: “Current choices in cervical cancer screening” by Ilana Cass, MD, and Claudia L. Werner, MD on the Contemporary OB/GYN website (December 6, 2021)

What's the difference between an HPV test and a Pap test?

The HPV test and Pap test are done the same way. A health professional uses a special tool to gently scrape or brush the cervix to remove cells for testing.

The American Cancer Society recommends a primary HPV test (done by itself for screening) as the preferred way to screen for cervical cancers or pre-cancers in individuals 25 to 65 years with a cervix. Only certain HPV test kits have been approved by FDA for primary tests.

Because a primary HPV test may not be an option everywhere, a co-test every 5 years (an HPV test done at the same time as the Pap test with the same swab or a second swab) or a Pap test every 3 years are still good options because they are all good at finding cancer and pre-cancer. But the primary HPV test is better at preventing cervical cancers than a Pap test done alone and does not add more unnecessary tests, which can happen with a co-test. The most important thing to remember is to get screened regularly, no matter which test you get.

Source: “HPV and HPV Testing” (American Cancer Society)

Cervical cancer screening guidelines

In a 2022 poll, 48% of U.S. women ages 18-64 said that the guidance about recommended Pap test frequency is misleading. And 46% of women 18 to 34, 47% of women ages 35 to 44, and 24% of women 45 to 64 said they have no idea how often they’re supposed to get a Pap test. 

Source: A November 2022 Harris Poll of 872 U.S. women ages 18 to 64.

Cervical cancer screening guidelines made simple

Cervical cancer screening guidelines can be confusing, but they don’t have to be. This video breaks down a complicated subject into a few simple steps.

A 3-minute video from the American Sexual Health Association

Centers for Disease Control and Prevention (CDC) (2021)

If you are 21 to 29 years old, you should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If you are 30 to 65 years old, talk to your doctor about which testing option is right for you:

  • Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.
  • HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
  • HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.

If you are older than 65, your doctor may tell you that you don’t need to be screened anymore if

  • you have had normal screening test results for several years, or
  • you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

Source: What Should I Know About Screening? (2021)

American Cancer Society (2020)

The American Cancer Society updated its guidelines in July 2020:

Women aged 25 to 65 should have a primary HPV test every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Pap test every 5 years or a Pap test alone every 3 years. The most important thing to remember is to get screened regularly, no matter which test you get.

Those over age 65 who have had regular screening in the past 10 years with normal results and no history of CIN2 (moderately abnormal cells found on the surface of the cervix) or more serious diagnosis within the past 25 years should stop cervical cancer screening. Once stopped, it should not be started again.

Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical cancer or serious pre-cancer.

Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above.

Women who have been vaccinated against HPV should still follow these guidelines for their age groups. Some people believe that they can stop cervical cancer screening once they have stopped having children. This is not true. They should continue to follow American Cancer Society guidelines.

Source: The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer

U.S. Preventive Services Task Force (2018)

Note: The USPSTF says it’s currently updating its screening recommendations for cervical cancer.

For women aged 21 to 29 years, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology (Pap test) alone. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).

The USPSTF recommends against screening for cervical cancer in (1) women younger than 21 years; (2) women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion; (3) in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine who make evidence-based recommendations about clinical preventive services. Most private insurance plans are required to cover without a copay recommended preventive services that receive a grade of A or B from the Task Force.

Insurance Coverage for Screening

Private health insurance. Coverage of cervical cancer screening tests is mandated by the Affordable Care Act (ACA or Obamacare), but that doesn’t apply to health plans that were in place before it was passed on September 23, 2010. If your plan started before that, it may still have coverage requirements mandated by your state, but each state is different.

Medicaid or public assistance: These programs in all 50 states and the District of Columbia cover screening for cervical cancer either routinely or on a doctor’s recommendation.

Medicare Part B. This covers tests used for cervical cancer screening, including a Pap test and pelvic exam every 2 years. For people at high risk for cervical or vaginal cancer, Medicare covers screening every year. This screening is provided without co-pay, co-insurance, or deductible as long as you go to a doctor that accepts Medicare.

Source: Cervical Cancer Prevention and Screening: Financial Issues

For low-income, uninsured, and underinsured women

CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screenings and diagnostic services to low-income, uninsured, and underinsured women across the United States.

You may be eligible for free or low-cost screenings if you meet these qualifications—

  • You have no insurance, or your insurance does not cover screening exams.
  • Your yearly income is at or below 250% of the federal poverty level.external icon
  • You are between 40 and 64 years of age for breast cancer screening.
  • You are between 21 and 64 years of age for cervical cancer screening.
  • Certain women who are younger or older may qualify for screening services.

For more information, visit CDC’s Find a Screening Program Near You.

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