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Cervical cancer screening

"By getting screened, we showing our daughters how to take care of themselves"

“Having the knowledge and following through with cervical cancer screenings are so important,” says singer and songwriter Ciara.

“This means visiting your OB/GYN for a regular Pap test from ages 21-29, and both a Pap test and HPV test together starting at 30. The Pap test finds changes to the cervix that can be addressed before they lead to cervical cancer. The HPV test identifies the presence of the human papillomavirus, which can also lead to cancer.

Testing is done as part of your well-woman exam — it’s that easy. That’s what self-care is all about, and it’s how we begin to take control and change the narrative.

As a mom of three, my health has become an even bigger priority for me,” says Singer and songwriter Ciara. Life is so precious, and I cherish all of the priceless moments with family and friends. It’s important to take charge of our health to make sure we are around for them.

We have it within us to help protect ourselves from cervical cancer. And when we do, we can embrace the fullness of who we are. We can actualize the purest form of self-love and reflect our truth: As Black women, we are in charge of our stories.”

Source: Ciara: “Black women can rewrite the narrative around cervical cancer” on the NBC News website (January 31, 2022)

Recommendations

“Cervical cancer is relatively easy to treat if it is caught at an early stage.”
The Society for Gynecologic Oncology

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

The American Cancer Society (ACS) recommendations on screening for cervical cancer are for individuals with a cervix who do not have symptoms of cervical cancer, who have never had a diagnosis of cervical cancer or precancer, and who do not have a health condition that weakens the immune system.
Screening for Cervical Cancer

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)

U.S. Preventive Services Task Force (2018)

Note: The USPSTF is currently updating its screening recommendations for cervical cancer (October 21, 2021)

For women aged 21 to 29 years, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology 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.

Recent news about cervical cancer screening

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

When to get screened

Maria Lynes-Eme, MD, discusses the recommendations for when to get screened for cervical cancer and when youth should receive the HPV vaccine.

A 2-minute video from Med Center Health of Kentucky

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.

HPV test. HPV is a virus that can cause cervix cell changes. The HPV test looks for cervical infection by 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 the Pap test (called a co-test) (with the same swab or a second swab), to determine your risk of developing cervical cancer. The American Cancer Society recommends a primary HPV test as the preferred way to screen for cervical cancers or pre-cancers in individuals 25 to 65 years with a cervix. (A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration has approved certain tests to be primary HPV tests.)

A Pap test is used to find cell changes or abnormal cells in the cervix. (These abnormal cells may be pre-cancer or cancer, but they may also be other things, too.) Cells from the cervix are sent to a lab and looked at closely to see if the cells are normal or if changes can be seen.

Because a primary HPV test may not be an option everywhere, a co-test every 5 years 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)

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 happens during a Pap test?

Pap tests, sometimes called Pap smears, 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.

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

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

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.

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.

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)

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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