Cervical Cancer and Pap Test Information (By the CDC)
Cervical cancer is nearly 100 percent preventable, yet according to the American Cancer Society, an estimated 13,000 new cases of invasive cervical cancer will be diagnosed in 2002 and about 4,100 women will die of the disease.1 The good news is that cervical cancer is preventable and curable if it is detected early; in fact, the occurrence of deaths from cervical cancer has declined significantly over the last 20 to 30 years
Cervical cancer rates are higher among older women; however, cervical intraepithelial neoplasia (or CIN), the precursor lesion to cervical cancer, most often occurs among younger women. Screening younger women using the Papanicolaou (Pap) test is an important strategy that can actually prevent cervical cancer from developing almost 100 percent of the time.
Minority populations and persons of low socioeconomic status are affected disproportionately as well.
Studies that have identified risk factors associated with cervical cancer have shown that cervical cancer is closely linked to
- failure to receive regular Pap test screening
- human papillomavirus (HPV) infection
- certain sexual behaviors (see paragraph below)
- immunosuppressive disorders such as HIV/AIDS
Bethesda 2001 updates the earlier Bethesda System, first published in 1989 and revised in 1991. The 2001 version reflects the most current knowledge about the biology of Pap test abnormalities and addresses new screening technologies that appeared in the past decade. The 2001 Bethesda System does not itself include guidelines for managing these abnormalities. However, it serves as the basis for new management guidelines that appear in companion articles (i.e., 2001 Consensus Guidelines for the Management of Women With Cervical Cytological Abnormalities and 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology) in the Journal of the American Medical Association, Volume 287, No. 16, April 24, 2002. The articles can be accessed at the following Web site: http://jama.ama-assn.org/. The guidelines were developed under the sponsorship of the American Society for Colposcopy and Cervical Pathology (ASCCP) in tandem with the 2001 Bethesda System. For a additional information, please see links below.
The U.S. Department of Health and Human Services has in place an independent panel of experts in primary care and disease prevention called the U.S. Preventive Services Task Force (1996). This task force systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. Currently, the task force recommends routine screening for cervical cancer for all women who are or have been sexually active and who have a cervix:
- Pap testing should begin at age 21 or 3 years after onset of sexual activity.
- Pap testing should be repeated at least every 3 years.
There is insufficient evidence to recommend for or against routine screening with cervicography, routine screening with colposcopy, and screening for human papilloma virus infection, although recommendations against such screening can be made on other grounds.
Many organizations, including the American Cancer Society, National Cancer Institute, American College of Obstetricians and Gynecologists, American Medical Association, American Academy of Family Physicians, and others also recommend that Pap testing should
- begin pap testing 3 years after onset of sexual activity or at age 21.
- for women 30 and under, test annually with conventional pap test or every 2 years if using a liquid based pap test.
- For women over 30, testing may be done every 2-3 years after 3 consecutive normal pap tests (unless DES exposed or immunosuppressed).
1 Source: Cancer Facts and Figures 2002, American Cancer Society, 2002