No Need to Over-Screen

Cervical cancer screening is vital for certain groups but unnecessary for others

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Cervical cancer rates are so low in certain groups, the medical community no longer recommends bothering with routine screening. But in groups at risk, screening rates should be higher.

The Centers for Disease Control and Prevention has released 10 years worth of data on cervical cancer screening practices in the United States. Women under the age of 21, over the age of 65, or women who have had a hysterectomy for a non-cancerous reason, do not need regular Pap tests.

Their recommendation is women in high-risk groups and between the ages of 21-65 be screened every 3 years.

"Talk to your doctor about Pap smear tests."

Meg Watson, MPH, epidemiologist, and Keisha Houston, DrPh, Epidemic Intelligence Service officer, in the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC), contributed to analysis of cervical cancer screening trends in the US.

For the studies, information from the CDC’s Behavior Risk Factor Surveillance System from 2000-2010 was compiled and reviewed for Pap test demographics. The American Cancer Society (ACS), US Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG) have differed over the years in preventive guidelines.

In 2012, all three organizations agreed cervical cancer screening, in the form of a Pap test, is unnecessary for women under the age of 21 and over the age of 65 unless they are in a high-risk category.

The age of initiation of sexual activity does not change the age recommendation of 21 and older. Women aged 21-30 should get screened every three years.

For the first study, 125,297 women aged 18-30 from all 50 states were surveyed over the phone about their experiences with cervical cancer screening from 2000-2010.

In 2000, a total of 26 percent of women between the ages of 18-30 said they had never been screened for cervical cancer. By 2010, that number had increased to 48 percent.

From 2000 to 2010, women aged 18-21 who said they had been screened for cervical cancer in the last 12 months dropped from 65 percent to 42 percent.

From 2000 to 2010, women aged 22-30 who said they had gone through with screening in the last 12 months dropped from 78 percent to 67 percent.

While these numbers reflect the direction that the three health agencies have encouraged, the number of women aged 22-30 who have never been screened has increased from 7 percent to 9 percent from 2000-2010.

For the second study, researchers asked women over 30 who had a hysterectomy for a benign disease, meaning the removal of the uterus and cervix for anything but a dangerous cancer, and women over 65 not in high-risk categories, about their cervical cancer screening practices.

Guidelines state there is no clear benefit for these women to undergo continued screening.

In 2000, a total of 81 percent of women who had undergone a hysterectomy reported they were still getting routine Pap tests. In 2010, the numbers dropped to 69 percent.

In 2000, a total of 74 percent of women over the age of 65 reported getting routine Pap tests. In 2010, the numbers dropped to 65 percent.

Ms. Watson said, “As we monitor Pap test use among US women, we can make sure that women are being screened in accordance with guidelines, to best maximize the benefits of screening and minimize the harms.”

Dr. Houston said, “The good news is we are focusing our public health efforts on women at highest risk, while decreasing screening for women under age 21, when cervical cancer is rare and screening is not recommended.”

“We need to remain vigilant and increase screening among women who would benefit most from this preventive service.”

Cervical cancer screening tests can range between $50-$200; however, many insurance companies cover the Pap test with no additional copay.

These reports were published in January on the Centers for Disease Control and Prevention website in the Morbidity and Mortality Weekly Report.

Reviewed by: 
Review Date: 
January 7, 2013
Last Updated:
January 8, 2013