Cervical Cancer Screening

Cervical cancer screening is an important preventive step that can help detect changes in the cervix before cancers can develop. Screening is critical to reducing mortality: when detected early, the five-year relative survival rate between 2009 and 2015 was 92% for cervical cancer classified as localized by the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database, compared with 17% for cancers detected at the distant stage (3). Still, the American Cancer Society (ACS) estimates 13,800 new cervical cancer diagnoses and 4,290 cervical cancer deaths in 2020 (1).

At one time, cervical cancer was one of the most common causes of cancer deaths among U.S. individuals with a cervix; however, between 1955 and 1992, the incidence and death rates of U.S. cervical cancer declined by more than 60%. This decrease can be attributed largely to the development of the Papanicolaou test (Pap smear or Pap test)—one of the most effective cancer screening tests available (2).

Current professional guidelines include three approaches to cervical cancer screening: human papillomavirus (HPV) testing alone, which detects the presence of certain high-risk strains of HPV in cervical cells; Pap testing alone; and HPV/Pap cotesting, which checks the same cell sample for both high-risk HPV types and cervical cell changes. These methods are discussed in Screening Methods. Additional updates to the guidelines are discussed in detail in Cervical Cancer Screening Guidelines.

When used correctly, these tests can potentially improve the early detection of cervical cancer. However, it is important to recognize that these tests are still imperfect tools designed to screen populations rather than definitively diagnose disease in individuals, and human and systems errors can reduce the reliability of these tests. For example, the Pap test and the HPV test are prone to both false-negative and false-positive results. False positive results can lead to patient anxiety and additional unnecessary expensive diagnostic evaluation and testing, such as colposcopy and biopsy. False negative reports can cause a delay in appropriate follow-up testing and procedures. (6)

In addition, other factors such as test tracking and follow-up, obtaining an accurate patient history, and proper documentation are also important...