Age matters when it comes to screening for cervical cancer

Getting checked for cervical cancer isn’t one-size-fits-all: Millions of women may soon have to decide between a routine Pap or a newer test that detects if they have a cancercausing virus.

Draft U.S. national guidelines released Tuesday for the first time say either option is reasonable for certain women — those ages 30 to 65.

Paps, a mainstay for women’s health for decades, can spot pre-cancerous abnormalities in time to prevent cancer. Newer HPV tests detect the virus that causes nearly all of that cancer, and while they’re widely used to confirm Pap results, most U.S. medical groups haven’t yet pushed them as a stand-alone alternative for screening.

Tuesday’s proposal doesn’t signal an imminent end to the Pap era. Paps, not HPV tests, still are recommended for screening women in their 20s, stressed the guidelines from the U.S. Preventive Services Task Force.

And don’t let the which-test debate blur the main message: “Screening for cervical cancer saves lives,” said Task Force member Dr. Carol Mangione of the University of California, Los Angeles.

Today, too many women still miss out. Some things to know:

Cervical cancer still a threat

Cervical cancer has dropped dramatically over the past halfcentury thanks to Pap testing. Still, this year an estimated 12,820 U.S. women will be diagnosed with cervical cancer, and about 4,200 will die. Most haven’t been screened, or have gone too long between checks.

Paps examine cells scraped from the cervix. HPV testing looks for high-risk strains of the human papillomavirus, the nation’s most common sexually transmitted infection. According to the Centers for Disease Control and Prevention, just about everyone will get at least one strain at some point in their lives. But only certain strains cause cervical cancer — and only if they linger long enough in the body.

Age matters for screening

Otherwise healthy women need a Pap every three years from age 21 to 29, agree most U.S. physician groups and the draft Task Force guidelines. Cervical cancer grows so slowly that regular Paps can find a problem early enough to treat.

While the Food and Drug Administration has approved an HPV test for women as young as 25, national guidelines have long recommended Pap screening for 20-somethings. That age group is most likely to get HPV — and the vast majority of the time their bodies clear the infection before it harms.

What changes at age 30?

The older you get, the greater the chance that an HPV infection is the yearslong, harmful kind. To better catch those cases, today what’s called cotesting is increasingly common for women 30 and over — a Pap-plus-hpv test combination. If the results of both tests are negative, women can wait five years to test again.

But both Paps and HPV testing can trigger false alarms, prompting unneeded, and sometimes harmful, additional care to rule out cancer. New studies show co-testing leads to more false alarms than either test alone, without adding benefit.