The third most common cancer in women worldwide is Cervical cancer and is the second most frequent cause of cancer-related mortality with about 300,000 deaths annually (report.nih.gov, 2013). According to Siegel, Naishadham, & Jemal in 2013, there was an estimated 12,340 new cases of invasive cervical cancer in the United States and 4,030 estimated mortality. There was actually a 50% decrease in cancer death the past 30 years due to early detection using the Pap smear that provides detection of precancerous cells and cancerous cells in their earlier stage (Vegunta, Kransdorf, & Mayer, 2014).
Pap smear is used primarily to identify the cytology of the cervix and vagina and can also be used to identify presence of infection. Cervical cancer takes about 3–7 years for high-grade changes to occur and screening with Pap smear can detect these changes before they become cancer (The American Congress of Obstetricians and Gynecologists (ACOG), 2016)
The U.S. Preventive Services Task Force (USPSTF) (2016), recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years if co-testing with HPV (Human Papilloma Virus) is not obtainable (Langsjoen et al., 2015). However, beginning at age 30, the women who wants a longer interval of screening should combine cytology and HPV testing every 5 years (Moyer, 2012) because women older than 30 years correlates with increased incidence of high-grade lesions (Langsjoen et al., 2015).
The USPSTF discourages screening for cervical cancer through Pap smear for women younger than 21 years (Moyer, 2015). According to Vegunta, Kransdorf, & Mayer (2014), 90% of HPV infections resolve in 2 years and although women below 20 years have the most incidence of HPV infections, they have minimal risk of developing invasive cervical cancer. Also, false positive can lead to unnecessary treatment that have an adverse effect on childbearing (Mayer, 2015). An example is the loop electrosurgical excision procedure that is linked with preterm delivery and increased risk of premature rupture of membranes (Vegunta, Kransdorf, & Mayer, 2014).
The USPSTF also discourages Pap smear for women older than 65 years who had sufficient prior screening and are considered low risk, as well as those who had hysterectomy with cervical excision without history of High-Grade Precancerous or Cervical Cancer (Moyer, 2012). Based on a systematic review, risk of high-grade cervical lesions decreases with age and screening women older than 65 would not provide any benefit (Moyer, 2015). Sufficient prior screening means that a woman who does not have a history of moderate or severe abnormal cervical cells (dysplasia) or cervical cancer, and have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years (ACOG, 2016).
The American Congress of Obstetricians and Gynecologists (ACOG) recommends Pap smear screening for women who had hysterectomy but the cervix is not removed (2016). If the cervix is removed due to cervical cancer, Pap smear screening should be done for the next 20 years after surgery (ACOG, 2016). However, if the cervix is removed but there is no history of cervical cancer, there is no need for screening (ACOG, 2016). Frequent Pap smear screening is needed among women who were exposed to diethylstilbestrol before birth or have HIV (human immunodeficiency virus), immunocompromised or history of cervical cancer (ACOG, 2016).
Women are still encouraged to follow up for well-woman exam (pelvic exam or internal exam) and check-up for counseling on birth control, vaccination, health screening, and preconception (ACOG, 2016).