Opinion: Oncology Nurses Require an Understanding of Cervical Cancer Testing and Screening

It is important that oncology RNs and social workers be aware of the screening and testing guidelines for cervical cancer. For this second article in a weekly series for cervical cancer awareness month, we will look at the current screening recommendations.

Pap Smear Information

The Papanicolaou test can detect changes involving the cervix before they evolve into cancer. In addition, it can reveal changes after cancer has occurred. The goal of the Papanicolaou test is to find precancerous changes when it still at a precancerous stage.¹

When a woman goes for cervical cancer screening, the cervix is examined. The provider uses a speculum, which is plastic or metal, and is inserted inside the vagina. The physician, ARNP or physician assistant (PA) will then retrieve cervical cells as well as mucus from this area.¹ The specimen is then shipped to a laboratory for analysis.

The ordering provider will order a human papillomavirus (HPV) test if this is indicated.Unfortunately, cervical cancer is a silent killer. Unlike lung cancer, where the patient might have a cough, cervical precancer does not have clinical symptoms. Cervical precancer is a painless disease. That is why going for screening is vital.¹

HPV Test

An HPV test looks for the presence of HPV DNA in the cervix. The HPV test is similar to the Papanicolaou test; a provider will insert a speculum and then use a soft brush to collect cells from the outside of the cervix.²

HPV is a sexually transmitted infection (STI).² In many healthy individuals, this virus can disappear without treatment. Other times, this does not occur, and the patient may develop cervical cancer from this virus down the road.

Age Recommendations

Screening can start at age 21 to 29 years. Women within this age range should get a Papanicolaou test every 3 years.² Normal results will trigger the gynecology provider to instruct patients to have the next screening in 3 years.

For women between the ages 30 to 65 years, there are some options. Women can either get a Papanicolaou test every 3 weeks, or an HPV test every 5 years, or both a Papanicolaou test and HPV test together every 5 years. Going for only an HPV test is known as primary HPV testing.³ If it comes back normal, the gynecology provider will usually tell the patient that they can wait 5 years for the next test.

Getting an HPV test and a Papanicolaou test simultaneously is known as co-testing.³ Again, the patient can wait 5 years between tests if the results are negative. If the patient only has a Papanicolaou test, and this test result is negative, the patient will be told that they can wait 3 years till their next Papanicolaou test.

Older Women and Surgical History

Women older than 65 years have different guidelines depending on their health care history. Women who had a hysterectomy because of an abnormal cervical cells or cervical cancer, should continue to get Papanicolaou and HPV tests.

Women who have had their uterus removed but still have a cervix (which is uncommon), should continue to get Papanicolaou tests until they are age 65 years. Once they reach age 65 years, if they have 3 normal tests, or 2 normal co-tests in a row in the past 10 years, they may be able to stop testing.²

Results can take 3 weeks to receive despite today’s technology. The results will then determine if further testing is needed. If the patient has cervical cancer or precancer, following the health care provider’s recommendations are very important. Being lost to follow-up is not an option since because this cancer can metastasize.

Cost should not be a factor. In the United States, there is reduced or even free screening available at the National Breast and Cervical cancer Early Detection Program¹.

Special Populations

Screening those who belong to marginalized of minority and economically disadvantaged communities women is a priority in this country. In general, the National Institutes of Health (NIH) has published statistics that reveal that, in general, rates for cervical cancer have decreased since the year 2000. In addition, Hispanic women, some LGBTQ women, and women belonging to low-income communities, have lower cervical cancer testing rates.³

In a recent study by the journal Cancer Epidemiology, Biomarkers and Prevention, a systematic review of 43 studies indicated that medically underserved women prefer a self-test as well as providers who speak their language.Female health care providers are also wanted.³ The authors of the study concluded by noting that if these considerations are not included in cervical cancer screening, the gap in health care between the have and have nots will get worse.

References

1. What Should I Know About Screening? Centers for Disease Control and Prevention. December 14, 2022. Accessed January 13, 2023. Web site: https://bit.ly/3Hev5f7
2. Pap and HPV tests. Office on Women’s Health.February 22, 2021. Accessed January 12, 2023. https://bit.ly/3iLcRIM
3. Mix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC. Assessing impact of HPV vaccination on cervical cancer incidence among women aged 15-29 years in the United States, 1999-2017: an ecologic study. Cancer Epidemiol Biomarkers Prev. 2021;30(1):30-37. doi:10.1158/1055-9965.EPI-20-0846