Recent changes to cervical cancer screening guidelines that recommend less
stringent testing may result in a higher incidence of a particularly aggressive
type of cervical cancer in young women, a new study suggests.
When the US guidelines for cervical cancer screening were first changed in
March 2012, the differences were clear-cut: Women could start getting cervical
cancer screenings at a later age and an annual Pap test for everyone was being
replaced with a longer interval between screenings - typically three to five
years, as long as no abnormalities showed up in a test.
But the researchers found that the time from a first abnormal Pap test to a
diagnosis of this fast-moving cancer, known as adenocarcinoma of the cervix, was
21 months in women under 30 and 29 months for women older than 30.
"Any time national guidelines are changed pretty dramatically, I think it's
important to reassess areas that may have been weakened," said study author Dr
Lisa Barroilhet, an assistant professor of gynaecologic oncology at the
University of Wisconsin in Madison.
"I don't think the new guidelines will cause a rampant epidemic of
adenocarcinomas, [but] it's important to think about how a cure is obtained,
which often involves removing a significant portion of the cervix," Barroilhet
said. "If you're in your teens or 20s, you're probably not through with
Adenocarcinoma used to be a rarer cancer of the cervix than squamous cell
cancers. But because cervical cancer screening is so good at catching squamous
cell cancers, the rate of adenocarcinomas as a proportion of all cervical
cancers has been increasing, Barroilhet said. The early form of this cancer is
referred to as adenocarcinoma in situ.
Cervical cancers usually are detected through the use of the Pap screening
test, which involves collecting cells from the cervix and checking them for any
abnormalities. More recently, screening for the human papillomavirus (HPV) also
has become part of some cervical cancer screens. The HPV virus is responsible
for almost all cervical cancers, according to the US National Cancer
In general, the new recommendations are:
- No screening for women under 21.
- Women between the ages of 21 and 29 should have a Pap test every three
- A Pap test every three years or a combination Pap test along with testing
for HPV, for women between the ages of 30 and 65.
- Screening isn't recommended for women over 65 unless they have a higher risk
of cervical cancer or if they haven't gotten regular screenings in the
The current study reviewed a decade of a cases of women diagnosed with
adenocarcinoma in situ (AIS) at Brigham and Women's Hospital in Boston.
Find early and save a life
Of the 242 women who were diagnosed with AIS, 208 had shown an abnormality in
their Pap test. For two-thirds of those women, their Pap test initially
suggested squamous cell changes rather than AIS, according to the study.
Squamous cell cancers are much slower-moving cancers, Barroilhet said. For
the women in the study who were eventually diagnosed with AIS, however, the time
from their abnormal Pap test to a diagnosis of AIS was 29 months for women older
than 30, and just 21 months for those aged 30 and younger.
Seventeen cases occurred in women under 21, and 16 of these women had
abnormal Pap tests, according to the study.
Dr Elizabeth Poyner, a gynaecologic oncologist at Lenox Hill Hospital in New
York City, said it's particularly important to find these cancers early in women
of childbearing age, because the treatments that are necessary to save a woman's
life may compromise her fertility.
Barroilhet said these findings need to be confirmed in a larger group of
women, and with patients from more than just one hospital. She also said she
didn't think the current screening guidelines need to be re-examined due to the
"I think our screening guidelines were developed thoughtfully and
thoroughly," she said. But, she added, this study does show a potential weakness
in the guidelines.
Poyner agreed. "This is something we need to have a conversation about," she
said. "Will the new guidelines compromise our ability to find adenocarcinoma in
situ? Only time will tell for sure, but this is something we need to be
Barroilhet added that young women can take an important step to protect
themselves by getting vaccinated against HPV. The vaccine is recommended at age
12 or 13, but is approved for use in females from the ages of 9 to 26.
"If you get your HPV vaccine, the Pap screen then becomes much less
critical," Barroilhet said.
To learn more about the Pap test, visit the US
National Cancer Institute.