Cervical Cancer Screening Recommendations

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The number of American women who die from cervical cancer has decreased steadily over the past 40 years, due in large part to successful screening programs.

The recent development of the human papilloma virus (HPV) vaccine may further decrease rates of cervical cancer in this country, but vaccination must occur before the onset of sexual activity in order to be most effective, and the duration of the vaccine's protection is not yet known. Research shows that these vaccines are safe and effective in preventing precancerous changes of the cervix, but long term-effects on prevention are not known.

You may be at high risk for cervical cancer if you:

  • Currently or previously have had an abnormal Pap test or high-risk HPV test, treatment of your cervix for dysplasia, or Pap abnormalities. Of note, most women who test positive once for high-risk HPV will suppress the active virus and are not at high risk for cervical cancer. However, if you test positive more than once, your risk may go up and you should discuss further evaluation with your doctor;
  • Are immunosuppressed or are being treated with immunosuppressive medications;
  • Have never or infrequently been screened;
  • Have symptoms, such as abnormal bleeding, that have not been fully evaluated;
  • Smoke, which may increase your risk if you have already been infected with HPV. Quitting smoking may help your body more effectively get rid of HPV.

Screening Recommendations

Onset of sexual activity: If you are immunosuppressed or being treated with immunosuppressant medication, you should have your first Pap test with the onset of sexual activity, and then annually if the tests are normal.

21+: If you're healthy, you should have your first Pap screening test at age 21, and if it's normal, get one every three years until age 65.

30+: If you have had adequate and normal screening in your 20s, you may continue Pap testing every three years if results remain normal, or you may be screened with a combination of a Pap test and a high-risk HPV test every five years, if all results remain normal. Recent recommendations from the U.S. Preventive Services Task Force (USPSTF) offer an additional cervical cancer screening option for low risk women ages 30 to 65. In addition to selecting one of the two previous screening options, women can now choose to have just an HPV test every five years, if all prior tests are normal. Abnormal results usually require further testing. Speak to your doctor about what is recommended in your situation.

Vaccination to Prevent HPV Infection

The Centers for Disease Control (CDC) recommends vaccination for girls and young women between the ages of 9-26, ideally by age 11-12, before the onset of any sexual activity. The recommendation for boys and young men is ages 9-21.

Women who are vaccinated still need routine screening due to the fact that not all high-risk HPV subtypes are included in the current vaccine. New vaccines are being studied that will provide greater coverage, but they're not available yet.

In the future, a combination of HPV testing for screening and full vaccination of eligible children may radically reduce worldwide rates of cervical cancer.

Read the CDC Vaccine Information Statement.

Related Links

Ask the expert: Q & A on uterine, ovarian and cervical cancer

International team completes systematic, genomic study of cervical cancer

Should boys and girls be vaccinated against HPV?

DNA test may offer alternative to Pap smear