Cervical cancer screening

Worldwide, an estimated 660,000 new cases of cervical cancer were diagnosed in 2022, with approximately 350,000 deaths. WHO: cervical cancer Opens in new window​ Cervical cancer is the fourth most common cancer diagnosed in women and ranks second in resource-limited countries.

Cervical cancer is caused primarily by persistent infection of the cervix with human papillomavirus (HPV). HPV is a sexually transmitted infection and is common in sexually active individuals. Most infections resolve spontaneously, but persistent infection of the cervix, if untreated, can cause abnormal, precancerous cells to develop. Cervical screening can detect precancerous and cancerous lesions in asymptomatic women.[1]American College of Obstetricians and Gynecologists. Updated cervical cancer screening guidelines. Apr 2021 [internet publication]. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines [2]Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020 Apr;24(2):102-31. https://journals.lww.com/jlgtd/fulltext/2020/04000/2019_asccp_risk_based_management_consensus.3.aspx http://www.ncbi.nlm.nih.gov/pubmed/32243307?tool=bestpractice.com [3]Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 Sep;70(5):321-46. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21628 http://www.ncbi.nlm.nih.gov/pubmed/32729638?tool=bestpractice.com [4]Sawaya GF, Kulasingam S, Denberg TD, et al. Cervical cancer screening in average-risk women: best practice advice from the clinical guidelines committee of the American College of Physicians. Ann Intern Med. 2015;162:851-9. http://annals.org/article.aspx?articleid=2281177 http://www.ncbi.nlm.nih.gov/pubmed/25928075?tool=bestpractice.com [5]US Preventive Services Task Force., Curry SJ, Krist AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018 Aug 21;320(7):674-86. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening http://www.ncbi.nlm.nih.gov/pubmed/30140884?tool=bestpractice.com ​​​​

Cervical cancer screening has been hailed as one of the most successful preventive medical strategies. It has been associated with a 70% reduction in cervical cancer mortality in developed countries since the introduction of the Papanicolaou (Pap) test in 1941.[6]Wright TC Jr. Cervical cancer screening in the 21st century: is it time to retire the PAP smear? Clin Obstet Gynecol. 2007;50:313-323. http://www.ncbi.nlm.nih.gov/pubmed/17513921?tool=bestpractice.com [7]Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21763 http://www.ncbi.nlm.nih.gov/pubmed/36633525?tool=bestpractice.com Cancer Research UK: cervical cancer mortality statistics Opens in new window​​​​[Figure caption and citation for the preceding image starts]: Colposcopic view of cervical carcinomaCenters for Disease Control and Prevention (CDC) [Citation ends].

HPV infection of cervical epithelial cells is associated with characteristic morphologic changes, and the presence of HPV can, therefore, be indicated by histopathologic observation. HPV tests, either alone or with cytology, are a newer method of cervical cancer screening.

Cervical cancer is rare in women under the ages 21 years. Routine screening is recommended for those with a cervix ages 21 years to 65 years. Screening may be clinically indicated in women over the ages 65 years who have not had adequate prior screening or are at high risk of cervical cancer. Women who have undergone total hysterectomy (i.e., their cervix has been removed) no longer need cervical cancer screening, as long as they have no previous history of cervical cancer or dysplasia. Women of any age who have a limited life expectancy can also discontinue cervical cancer screening.[1]American College of Obstetricians and Gynecologists. Updated cervical cancer screening guidelines. Apr 2021 [internet publication]. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines [3]Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 Sep;70(5):321-46. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21628 http://www.ncbi.nlm.nih.gov/pubmed/32729638?tool=bestpractice.com [4]Sawaya GF, Kulasingam S, Denberg TD, et al. Cervical cancer screening in average-risk women: best practice advice from the clinical guidelines committee of the American College of Physicians. Ann Intern Med. 2015;162:851-9. http://annals.org/article.aspx?articleid=2281177 http://www.ncbi.nlm.nih.gov/pubmed/25928075?tool=bestpractice.com [5]US Preventive Services Task Force., Curry SJ, Krist AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018 Aug 21;320(7):674-86. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening http://www.ncbi.nlm.nih.gov/pubmed/30140884?tool=bestpractice.com

National Cancer Institute: cervical cancer screening Opens in new window

ACOG: cervical cancer screening FAQs Opens in new window

See  Cervical cancer​