The American Cancer Society (ACS) (2012) estimated that American women experienced 12,170 new diagnoses of cervical cancer and 4,220 cervical cancer deaths in 2012. These estimates represent approximately 33 new cervical cancer cases and 12 cervical cancer deaths per day in the United States from a disease that is largely preventable through effective screening of appropriate women (National Cancer Institute, 2012). Unfortunately, women who were never screened or inadequately screened suffer the majority of cervical cancer morbidity and mortality (American College of Obstetricians and Gynecologists [ACOG], 2012).
Papanicolaou (Pap) Test screening recommendations have changed due to advances in technology and, most importantly, in understanding of the epidemiology, etiology, and pathophysiology of invasive cervical cancer. In 2012, revised cervical cancer screening recommendations were endorsed by ACOG (2012), ACS (2012), and U.S. Preventive Services Task Force (Moyer, 2012). These recommendations are for women regardless of sexual history who have a cervix, have not been diagnosed with cervical cancer or high-grade intraepithelial neoplasia, were not exposed to diethylstilbestrol in utero, and are not immunocompromised, such as women with HIV infection (Saslow et al., 2012). In brief, revised recommendations include the following:
- Cervical cancer screening begins at age 21. Screening before age 21 is not recommended regardless of age of sexual debut.
- Between 21 and 30 years of age, cervical cancer screening is done only with cytology screening (conventional or liquid-based specimen collection) every 3 years. Women younger than age 30 should not be screened with human papilloma virus (HPV) testing alone or HPV testing in combination with cytology.
- Between age 30 and 65, cervical cancer screening is done with cotesting via cytology and HPV testing every 5 years, or with cytology alone every 3 years.
- Cervical cancer screening is discontinued by any method after age 65 for women with adequate prior screening and no history of cervical intraepithelial neoplasia (CIN) 2 or higher.
- Cervical cancer screening is discontinued by any method in women after hysterectomy for benign indications that includes removal of the cervix. This recommendation is for women with no prior diagnosis of cervical cancer or CIN 2 or higher.
- Cervical cancer screening is the same for women who have and have not received the HPV vaccine. Currently, an absence of long-term data for women who have been vaccinated precludes differential recommendations based on vaccination status.
Based on the best available scientific evidence, these recommendations maximize the benefits while decreasing the harms of early detection, intervention, and treatment. The goal is to effectively reduce cervical cancer incidence and mortality through appropriate use of available screening modalities while avoiding the physical, psychological, and financial costs of injudicious and unnecessary screening and treatment (Moyer, 2012).
Nurses can advance this goal through efforts to ensure that all women understand the need for appropriate screening and have access to high-quality care and follow-up based on the most current recommendations. Advanced practice nurses are in key positions to implement and educate women about these cervical cancer screening recommendations and to advance system-level changes needed to ensure their adoption in primary care.