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Women's Cancer Screening Update

Important Changes in Cancer Screening for Women

Feb 1, 2015
Posted by: Douwe Rienstra, MD

Pap Smears

While it appeared previously that Pap smears were no longer required if you had negative HPV testing, it turns out that HPV testing can miss certain dangerous strains of the virus.  A woman over the age of 30 with a negative HPV test still benefits from a Pap smear every 5 years.  if she has a positive test, or doesn't know her HPV status, then she needs a Pap smear every 3 years.

Once a woman reaches age 65, if she has had 3 consecutive negative Pap smears,  and has had no abnormal Pap smear in 10 years,  she does not require further testing.

Second, while I was among those who believed that once a woman had had a hysterectomy  that she no longer needed a Pap smear, many authorities consider this  wrong.  If a woman has had a hysterectomy  for reasons other than cancer, then she does not need any more Pap smears. But if she had a hysterectomy for cancer, level CIN 2 or greater, then she does need an annual Pap smear  for 20 years. The reason is that there can be apparently normal cells in the region that will later turn into cancer. 

Endometrial Cancer

A Pap smear detects cancer of the cervix, the opening of the uterus.  Endometrial cancer, which involves the lining of the uterus, does not show up on a Pap smear.  This mostly affects  postmenopausal women. This is why if you have spotting or bleeding after your menses have stopped and you are in menopause, you require evaluation for any  bleeding. The odds are that the bleeding is benign, but a single spot may be the only warning a woman will have of cancer of the endometrium.

Pesky Misinformation

The CA-125 is positive in many conditions besides cancer of the ovary. It is negative in about half the cases of cancer of the ovary. Women who show up positive on the CA-125 test most often have advanced cancer. Comparing women who are screened with CA-125 with those not so screened, there is no survival benefit to CA-125 screening. 

Other commonly hyped tests include proteonomic analysis, OVA-1, and other "multi-marker" tests.  About all these will accomplish is to lighten your purse.



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