Spotlight on Cervical Cancer: Risk Factors and Screening Best Practices

24 January is Cervical Health Awareness Month—a time for all healthcare stakeholders to become more mindful of risks associated with human papillomavirus (HPV) and cervical cancer. The fourth most common type of cancer for women worldwide, cervical cancer diagnoses impact more than 13,000 women in the United States annually and result in 4,000 deaths.

Thanks to widespread use of the pap test and proactive efforts to address cervical health in women, deaths associated with this form of cancer continue to decline by a couple of percentage points each year. The medical community can continue advancing this positive trend by understanding risk factors, educating patients and following evidence-based guidelines for screenings.

Notably, the presence of HPV poses the greatest risk for the occurrence of cervical cancer. Found in approximately 99 percent of cases, an HPV infection is believed to be a necessary precursor for the disease but not sufficient on its own for cancer to develop. In addition to HPV, the following factors increase the potential threat of cervical cancer:

Screenings are an all-important strategy for reducing the occurrence of cervical cancer and improving mortality rates. Currently, the industry uses three primary screening methods: cytology, HPV testing and visual inspection. In the U.S., cytology (pap smear) and HPV testing are accepted as the standard of care, although visual inspections have proven effective in third-world and developing countries.

Understanding age-based is important to ensure optimal outcomes and minimize potential harm to patients. The U.S. Preventive Services Task Force, American Congress of Obstetricians and Gynecologists, American Cancer Society, American Society for Colposcopy and Cervical Pathology (ASCCP) and the Society of Gynecologic Oncology offer the following guidelines for asymptomatic women:

  • Avoid screenings in women under the age of 21 due to low incidence of cervical cancer and the potential for unnecessary testing and harm.
  • Screenings every three years for women between the ages of 21 and 29. Interim guidance from the ASCCP and Society of Gynecologic Oncology also supports HPV screening in women 25 years and older as an alternative to cytology.
  • Engage cytology with high-risk HPV cotesting for women ages 30 to 65 every five years.
  • Discontinue screening at 65 years of age if a patient is low risk, defined by three consecutive negative cytology results or two negative results in a row within the past 10 years, with the most recent test performed within the last five years.
  • Discontinue screening in women who have had a hysterectomy with removal of the cervix for benign indications.
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