Major Shift in Cervical Cancer Screening: What the Proposed Guidelines Mean for Women

Getting checked for cervical cancer is looking to become a lot more convenient. An influential panel of experts is calling for new changes to the current recommendations surrounding cervical cancer screening—changes that should result in fewer pap smears for many women starting in their 30s.

On Tuesday, the U.S. Preventive Services Task Force issued its draft guidelines for the screening of cervical cancer in the U.S. The most notable difference will be recommending that women ages 30 to 65 only need to get tested for high-risk strains of the human papillomavirus (HPV) every five years, rather than needing to get pap smears every three years. The guidelines should make cervical cancer screening a less stressful experience for most American women.

The USPSTF is under the umbrella of the U.S. Department of Health and Human Services, but its members are voluntary outside experts brought in to review the evidence and to provide recommendations on a variety of topics related to preventive health care, including cancer screening. Its guidelines are widely followed by health care professionals and can even influence the insurance coverage of interventions like vaccines.

Currently, the USPSTF recommends that women ages 20 to 29 start getting screened for cervical cancer every three years via cervical cytology (the pap smear). Women between 30 and 65 are currently recommended to either receive a pap smear every three years, a high-risk HPV test every five years, or a combination pap smear/HPV test every five years. The USPTF’s recommendation for women in their 20s is staying the same, but its experts are now saying that women over 30 should primarily only opt for HPV testing every five years. These tests work by checking vaginal samples for types of HPV infection known to raise the risk of cervical cancer. Women over 65 are generally not advised to seek screening for cervical cancer if they’ve received regular testing before and are not at high risk otherwise, nor are women who have had total hysterectomies (where the cervix is removed) with no history of precancerous cervical lesions.

The USPTF’s stated rationale for the change is simple enough. High risk HPV infections are by far the leading cause of cervical cancer, accounting for nearly all cases. And in women over 30, looking for these infections first and foremost seems to be the most useful way to detect cervical cancer as early as possible, based on the evidence assessed by the USPTF.  Additionally, the USPTF has determined that self-collected HPV tests are just as valid for screening as those performed by a healthcare professional. Two HPV tests were recently approved by the Food and Drug Administration this year for self-collection.

“The latest science shows that screening for cervical cancer with an HPV test is the optimal approach for women who are 30 to 65 years old,” said Task Force vice chair John Wong, a primary care clinician in the Department of Medicine at Tufts Medical Center, in a statement from the USPTF announcing the news.

The guidelines will still call for women over 30 to receive pap smears or combination testing if the standard HPV test isn’t available. And patients and their doctors can still always choose the method they most prefer. It is possible that the USPTF’s draft recommendations could substantially change before they’re finalized next year, though this rarely happens (as usual, the USPTF is allowing the public and outside experts to weigh in on their decision, with the comment period open until mid-January). If these new guidelines are enshrined as expected, they should make cervical cancer screening a less time- and resource-intensive experience for many women in the U.S.

The expansion of screening and the arrival of vaccines that prevent most high-risk HPV infections have greatly reduced the incidence of cervical cancer in the U.S. and worldwide in recent decades, though it remains the fourth-most common cancer in women globally.