Cervical Cancer Screening
February 3, 2017 | Healthcare Risk, Quality, & Safety Guidance
Cervical cancer is the 14th most common cancer affecting U.S. women. For 2017, ACS estimates that about 12,820 new cases of cervical cancer will be diagnosed, and that about 4,210 women will die of cervical cancer (ACS, "Key Statistics"). Between 1955 and 1992, the incidence and death rates of U.S. cervical cancer declined by more than 60%, thanks largely to the development of the Papanicolaou test (Pap test or Pap smear)—one of the most effective cancer screening tests available (NIH). The Pap test enables clinicians to detect CIN so that it can be removed before it progresses to cervical cancer. The test also detects cervical cancer at an early stage.
However, the Pap test is imperfect, and its inherent fallibility, coupled with human and systems errors such as sampling errors, detection and screening errors, and interpretation errors, can reduce its reliability (Gupta et al.). A zero error rate may never be achieved with the Pap test, although new testing methods (e.g., cotesting using both the Pap test and the HPV DNA test) hold the promise of improving the early detection of cervical cancer, thus reducing the risk of patient harm from delayed or missed diagnosis, as well as related litigation against healthcare providers.
In recent years, several organizations have revised their screening guidelines, increasing the interval between cervical cancer screenings to three years for most women who are screened solely with the Pap test, and to five years for women who are cotested for cervical cancer using both the Pap test and the HPV test. These guidelines also address when to begin screening, how long screening should continue, and the frequency of screening, among other related issues. (For more information, see Cervical Cancer Screening Guidelines.)
During a Pap test, cells are removed by a healthcare provider (typically a doctor or nurse) by inserting a speculum into the vaginal canal, using a cotton swab to remove excess mucus from the cervical opening, and gently scraping a sample of cells from the cervix. Once the cells are removed, they are...