In the mid 20th century, Dr. George Papanicolaou published his initial research about abnormal cells in cervical scrapings and cervical cancer. The test that now bears his name, the “Pap” smear, is perhaps the most successful cancer screening test in modern medical history. Cervical cancer was the leading cause of cancer deaths in American women in the early 20th century; but since widespread screening began, cervical cancer rates have fallen by 70%. The Pap smear works by finding abnormal cells before symptoms of cervical cancer appear. Cervical cancer is prevented by treating pre-cancerous lesions of the cervix, known as cervical dysplasia. Gynecologists have a number of minor office surgeries to treat cervical dysplasia, such as freezing or removing the abnormal cells.
Despite this success, recommendations for cervical cancer screening and pap smears have changed dramatically in recent years. Many of these changes reflect a better understanding of the cause of cervical cancer. Almost all cervical cancers and cervical dysplasia are caused by a viral infection with human papillomavirus, or HPV. A majority of women have a HPV infection at some point in their adult lives. Most men and women infected with HPV will resolve the infections without any signs or symptoms. A small minority of women with an HPV infection will develop abnormal pap smears, cervical dysplasia and cervical cancer. HPV does the most damage when it is persistent. It will take years and maybe decades from initial HPV infection to develop cervical dysplasia and cervical cancer.
The American Cancer Society updated its cervical cancer screening guidelines in 2012. For women over 30 years of age, cervical cancer screening can include both an HPV test and a traditional Pap smear. More than 90 percent of women will have a negative HPV test and negative Pap smear. This is very reassuring news for these women. The combination of these two tests will detect nearly all cases of cervical dysplasia and cervical cancer. Furthermore, women who are negative for both tests are highly unlikely to develop cervical cancer in the next five years. The American Cancer Society and other professional organizations have recommended that women between the ages of 30 and 65 have a Pap smear and HPV test every five years to screen for cervical cancer.
HPV testing in women under 30 years old is not recommended. HPV infections are common in this age group, and cervical cancer is relatively rare in women under 30.
The “annual exam” is a time-honored tradition for gynecologists in the United States, based on Dr. Papanicolaou’s historic breakthrough in the 20th century. In this century, multiple new tests and screening strategies have been developed, as well as an HPV vaccine recommended for girls age 9 through 26, to protect against the two types of HPV that cause most cervical cancers (click here for more on the HPV vaccine).
These new guidelines reflect a better understanding of the cause of cervical cancer, and promise to further reduce the burden of cervical cancer in women worldwide.
Author: Kevin Ault, MD
Winship Cancer Institute member and Professor, Gynecology and Obstetrics, Emory University School of Medicine
About Dr. Kevin Ault
Dr. Ault is currently Professor of Gynecology and Obstetrics at the Emory University School of Medicine and a Winship Cancer Institute member. Dr. Ault’s research interests are based in infectious diseases and women’s health. He is an investigator in vaccine trials for both herpes simplex virus and human papilloma virus. His multidisciplinary research in the pathogenesis of infections due to chlamydia and gonorrhea has been supported by the National Institutes of Health. Board certified by the American Board of Obstetrics and Gynecology since 1995, Dr. Ault came to Emory in 2005 from the University of Iowa Hospitals and Clinics in Iowa City.