PAP Smear – screening for cervical cancer

Who should be screened for cervical cancer?

Evidence supports the screening of cervical cancer with a PAP smear for all women between the ages of 21-65 every 3 years. Women over the age of 30 who wish to get checked every 5 years instead can do a PAP smear as well as human papilloma virus (HPV) test. There is no evidence to support a combined HPV test and PAP smear for women under the age of 30, as well as no evidence to support the benefits for testing women under the age of 21. If a woman has undergone a hysterectomy there is no evidence to support continued screening, nor is there evidence to support screening women after the age of 65 who have been screened properly before they got to that age. Women over 65 but have never been screened, have a strong recommendation to be screened. If you fall in a category that is not stated clearly above, it is important to consult with you physician.

What is a PAP smear?

A PAP smear is a test in which the cells of the cervix are tested for abnormal growth patterns. It is taken by gently scraping the inside of the cervix to obtain a sample of cells, and may be slightly uncomfortable though does not have lasting effects. Abnormal results of the test don’t necessarily mean that you have cancer. That being said, your physician may alter the interval between tests, or recommend other tests in order to further examine your situation.

 

Does screening really work?

There is a wide range of numbers explaining just how much screening the general population can reduce mortality for cervical cancer, though the fact that there is a great improvement is undeniable. Mortality rates from cervical cancer are reduced anywhere from 20-60%, and there has also been a drastic drop in the incidences of invasive types of cancer in populations that have been screened, versus populations that haven’t. The fact is, evidence is very convincing for the benefits of screening women as recommended above.

What don’t we know, and where should we be skeptical?

There is uncertainty as to the exact age in which we should start screening, the exact age we should stop screening, and the ideal interval between each test. What we do know, is that a 3 year interval is much more effective than a 10 year interval, and there was no more benefit to screening annually than screening every 3 years. In addition, the strongest evidence suggest the greatest amount of benefit for women after the age of 35, however recommendations have aimed at starting a few years before.

What can we do about it?

The gold standard for dealing with abnormal cells in the cervix is a surgical removal with one of a number of techniques. There is a very substantial benefit to treating these growths before they have the chance to expand and become invasive, and this is why it’s important to catch them early. However, early is a relative term, and in this case there is no reason to be checked more frequently than the recommendations in order to obtain the benefits of early diagnosis.

Are these the only recommendations?

Of course not. There are many different bodies providing different recommendations. However, this is based on large amounts of data, and many studies that were conducted. It’s very important to understand the data in order to make rational decisions that are based on evidence, and not put yourself through excessive risk, harm, pain and anxiety.

*Please comment to us if you found this information useful, or if you have any questions about the topic.

Here are a few studies which prove the efficacy of screening and early treatment for cervical cancer. Feel free to contact us for more information about the matter, we would be happy to provide it to you.

Knowledge is power. It’s very important for each of us to understand what our options are, and what evidence supports each option. Preventing diseases before they start is often the most efficient way to be healthy, and this starts by screening for the diseases that are appropriate for us depending on age, gender, and other factors. Download our app to go through a short list of questions, and receive a personalized list of the appropriate screening recommendations for you. More information about each of these tests is provided through the app, so that you can stay informed and educated.

 
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Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies. IARC Working Group on evaluation of cervical cancer screening programmes. Br Med J (Clin Res Ed). 1986;293:659-64. [PMID: 3092971]

Whitlock EP, Vesco KK, Eder M, Lin JS, Senger CA, Burda BU. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:687-97, W214-5. [PMID: 22006930]

Kitchener HC, Almonte M, Gilham C, Dowie R, Stoykova B, Sargent A, et al; ARTISTIC Trial Study Group. ARTISTIC: a randomised trial of human papillomavirus (HPV) testing in primary cervical screening. Health Technol Assess. 2009;13:1-150, iii-iv. [PMID: 19891902]

Vesco KK, Whitlock EP, Eder M, Burda BU, Senger CA, Lutz K. Risk factors and other epidemiologic considerations for cervical cancer screening: a narrative review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:698-705, W216. [PMID: 22006929]

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