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New cervical cancer screening recommendations include more options

Women ages 30 to 65 now have three choices in cervical cancer screening

Women over 30 years old have a new option when it comes to screening for cervical cancer, according to guidelines released Tuesday by the US Preventive Services Task Force and published in the journal JAMA.

Because most cervical cancer is caused by the human papillomavirus, also known as HPV, women 30 to 65 can opt to get an HPV test every five years, a Pap test every three years or a combination of both tests every five years.

In the past, the recommendations for women in that age group had suggested a Pap every three years and co-testing every five years.

However, for women between 21 and 30, the previous recommendation of only a Pap smear every three years remains in place. That has been a guideline since the introduction of the Pap, also called exfoliative cytology, 75 years ago.

In 2012, the task force — an independent panel of experts that makes recommendations to the American public about preventive services — set guidelines for other ages. Women under 21 normally should not be tested. Because cervical cancer is a slowly progressive disease and doesn’t show signs until it is advanced, testing at that age will show only evidence of human papillomavirus infections.

Women over 65 who have had recent negative tests also can forgo testing if they wish. However, Pap and HPV tests do not check for early signs of other cancers or sexually transmitted diseases, specialists warn, so women should continue to visit their health care practitioners on a regular basis.

Some strains of HPV cause cell changes on a woman’s cervix, which can lead to cervical cancer over 10 to 15 years, according to the US Centers for Disease Control and Prevention. Other strains cause genital warts, but those are very different from the ones that cause cancer.

Worldwide, cervical cancer is the fourth most common cancer in women. Women with advanced cervical cancer may have abnormal bleeding, unusual vaginal discharge or pain.

It strikes women in low-resource countries hardest, as they have limited access to medical care and therefore less screening and prevention.

Although the US has seen dramatic declines in cases of cervical cancer over the past 50 years, 13,240 new cases of cervical cancer and 4,170 cervical cancer deaths “are projected to occur” this year, Florida Atlantic University’s Dr. Lee Learman and the University of Arizona’s Dr. Francisco Garcia wrote in an editorial published alongside the new guidelines in JAMA.

The vast majority of those deaths will be “among poor women, women from communities of color, non-US-born women, and women living in rural and remote settings,” who also have little access to preventive care,Learman and Garcia wrote.

The recent introduction of an HPV vaccination protocol for adolescents has made eliminating cervical cancer a possibility, the doctors said, but parental adoption of the vaccine has not been as high as hoped.