Explaining the best time to get screened for cervical cancer

  Cervical cancer is one of the common gynecologic malignancies. It has the third highest incidence rate among female malignancies worldwide. There are about 530,000 new cases of cervical cancer worldwide each year. There are 275,000 deaths each year, 85% of which occur in developing countries. Early diagnosis and treatment are important means to prevent and treat cervical cancer. For women of different ages, cervical cancer screening is very necessary.  Cervical cancer screening is not recommended for women under the age of 21. Because of the low incidence of cervical cancer in young women, HPV infection is acquired after sexual intercourse and other sexual activities in young women, and almost all infections are cleared by the body’s immune system within 1 to 2 years without producing tumor-like changes.  For women under 21 years of age, cervical cancer prevention and treatment strategies include HPV vaccination and protected sex to prevent infection with sexually transmitted diseases.  Women aged 21-29 years should undergo cervical cytology screening alone, once every 3 years. HPV infection in women under 30 years is mostly transient and not potentially carcinogenic. Women in this age group are more sexually active and have a high incidence of HPV infection and a low incidence of cervical cancer, so combined screening is not indicated for this age group.  Women aged 30-65 years Combined cytology and HPV screening is recommended as a priority, once every 5 years; cytology screening can also be done once every 3 years. It has been demonstrated that women aged 30 years and older who have negative cervical cytology screening and HPV test results have an extremely low risk of developing CIN2 or 3 over the following 4 to 6 years, and this risk is much lower than in women with negative cytology results only. Cytology alone has a lower detection rate for cervical adenocarcinoma than for squamous cervical cancer, so combined screening has a better advantage for cervical adenocarcinoma and precancerous lesions.  In women over 25 years of age, initial HPV screening can be an alternative to current cytology-based cervical cancer screening methods. This is why the best time to screen for cervical cancer is between the ages of 25 and 65.  At what point can screening not be used?  For women with a clear negative prior screening result and no CIN2 or higher lesions, screening of any kind should be discontinued after age 65.  What is a “clear negative prior screening result”?  Defined as three consecutive negative cytology or two consecutive negative co-test results within the last 10 years, with the most recent screening performed within the last 5 years.  Women with a previous history of CIN2, CIN3 or adenocarcinoma in situ should be screened continuously for 20 years after spontaneous regression of the lesion or clinical treatment, or even extended screening beyond 65 years of age.  Do women who have had a hysterectomy still need to be screened?  Women who have had a total hysterectomy without previous CIN2 or higher lesions do not need to undergo routine cytologic screening and HPV testing, and there is no reason to restart screening.  Women with previous total hysterectomy with CIN2 or higher lesions may still have postoperative intraepithelial neoplasia or invasive carcinoma of the vaginal stump. Cytologic screening every 3 years and continuing for 20 years after the initial treatment monitoring period is a reasonable recommendation.