Young Women Are Skipping Cervical Cancer Screenings. What's Going On?
Changing guidelines have made knowing what well-woman tests you need—and when—confusing.
Real talk: When was the last time you got a Pap test?
A new study found an alarming trend in who is getting Pap tests and when. The research, published in the Journal of Women’s Health, looked at women ages 16 and older living in Olmsted County, Minnesota from 2005 to 2016. In 2016, just 64.6% of women ages 30–65 were up to date with their screenings. Among women ages 21–29, just 53.8% were up to date on testing. In fact, the researchers found a decreasing trend for Pap tests in every age group.
So, what’s going on? What feels like constantly changing screening recommendations may have had an unexpected impact: Women may have gotten out of the habit of going. It used to be that you went to the gynecologist every year for a Pap test. Then, in 2012 those recommendations changed. Making it more complicated, they varied depending on your age, risk factors, and results of past testing, but are generally the following:
- For women ages 21 to 65: Pap every three years
- For women ages 30 to 65: Continue with Pap tests every three years or opt for Pap plus HPV testing—called “cotesting”—every five years
A pap test detects abnormal changes in cells in the cervix that may indicate the presence of precancer. An HPV test detects the presence of one of the strains of the virus that can cause cancer. Both are necessary at the right ages.
“Ever since the guideline that you don’t need a Pap yearly, patients have translated that into I guess I only have to see my doctor every three years,” says Mount Kisco, New York ob-gyn Alyssa Dweck, MD, author of The Complete A to Z for Your V. That means women aren’t seeing their gynecologists annually (as they should whether or not they’re due for a Pap), and getting out of this habit may mean they forget to get tested on time.
There’s also the issue of access to health care. Under the Affordable Care Act, all Marketplace health plans (and many private insurers) are required to cover a cervical cancer screening following the guidelines above at an in-network doctor, along with screening for STIs like chlamydia, gonorrhea, HIV, and syphilis and well-woman visits. Age 26 is when women are coming off of their parent’s insurance; after that they may remain uninsured and skip these preventive services, says Dr. Dweck.
What’s more, adds Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, some women might think that getting the HPV vaccine means they don’t need screenings. “You still need to be screened for other STIs as well as cervical cancers,” she says. “While the vaccine certainly reduces the risk of getting cervical cancer, it’s not 100%. There are still plenty of other nasty HPVs out there.”
Then, there’s denial. “Women think that it won’t happen to them, but cervical cancer is still a fairly common cancer, and it’s preventable because we can pick it up early and treat it,” says Dr. Dweck. Let’s sober up with a couple stats from the American Cancer Society: In 2019, an estimated 13,170 new cases of invasive cervical cancer will be diagnosed, and 4,250 women will die from the cancer. It is most often diagnosed in women ages 35–44, so you can see why following the recommended screening schedule after age 30 is so crucial.
Another consideration: There’s the misunderstanding that if you don’t have symptoms there’s nothing wrong with you. “That’s not true! The hallmark of cervical cancer is that there are no symptoms [when it comes to precancer],” says Chicago-area ob-gyn Wendy Goodall McDonald, MD, of Dr. Every Woman. You can Google “cervical cancer symptoms” all you want, but in the beginning, most women don’t have abnormal discharge or experience menstrual changes, she says: “Detecting precancerous changes in the cervix requires a microscopic evaluation.” And that’s with an on-time Pap.
Can't you just test at home?
While right now nothing takes the place of an annual visit to the gynecologist, at-home HPV testing is emerging, and it is certainly a better option than nothing, says Dr. Dweck. And research is showing it works: In one study from Ohio State University, researchers mailed an at-home test to women ages 30–65 in Appalachian Ohio (an underserved and under-screened area) who hadn’t had a Pap test in at least three years. A full 78% of the women took the test and returned it, with about one-quarter having a detectable strain of HPV.
One brand, Nurx, offers an at-home HPV screening test. The company sets up a telehealth consultation, which is important in order to understand testing. “People can have a lot of anxiety over a positive test. Not all positive results mean there is cancer, so you need counseling to help you interpret the results. Still, we’re a long way from these at-home tests being usual care,” says Dr. Dweck.
Speaking of that annual visit: Commit to keeping it this year. When you go to the gyno, immediately make an appointment for your next one a year out, says Dr. McDonald. You can always change it if need be, but at least you have it on your calendar.
“I still think an annual checkup with a gynecological health care provider—gynecologist, nurse midwife, nurse practitioner—is a good idea,” says Dr. Minkin. “Even if you don't do an annual Pap test, you still need to be checked for STIs if you are sexually active with more than one person and particularly if you are not practicing safe sex.” Those annual checkups also give you a chance to talk to your care provider about whether or not the contraception you’re using is working for you or about pregnancy planning if applicable, she says.
You may have already set your resolutions for this year but add a Pap and/or HPV test to your list. And make it the one resolution you keep.
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