Ladies, Listen Up: Understanding Guidelines for Cervical Cancer Screening

by Alex McLearen

February 2022

Whether it's a personal experience with cancer, or watching a loved one go through it, almost everyone has known someone affected by cancer. North Dakota women are smart and know that if they are going to prevent a cancer, getting screened for cervical cancer in particular is an important way to prevent death from this type of cancer.

Cervical cancer is a cancer that grows at the top of the vagina from the cells that line the opening of the uterus, an area called the cervix. To test for cervical cancer – as part of a routine physical exam or at a dedicated appointment – cervical cells are collected when a woman's healthcare provider brushes cells from the cervix. This test is called a Pap smear, short for Papanicolaou test, and the collected cells are examined under the microscope by a pathologist who not only looks for cancer cells but looks for changes that can indicate cells are at an increased risk of turning into cervical cancer.

Unlike other cancers, most cases of cervical cancer are caused by a virus called human papillomavirus, or HPV. Many women never even know they have HPV because the virus generally does not cause symptoms and a healthy immune system fights it off. But HPV can also cause a long-lasting silent infection that can ultimately turn into cancer.

Nowadays HPV can be detected by specifically testing for it at the time the Pap smear is collected. This is called co-testing. The extra test can pick up strains of the HPV virus that are more “high-risk,” meaning scientists see these strains present most often in cervical cancer. These high-risk strains are hard for even healthy immune systems to clear. Women at risk for persistent infection are those who have a family history of cervical cancer, smoke cigarettes, or have a weakened immune system, like people with human immunodeficiency virus, or HIV.

The United States Preventive Services Task Force (USPSTF) recommends women start cervical cancer screening for abnormal cells at the age of 21. If tests are negative through age 29, recommendations change for women aged 30-65 with the task force suggesting three different testing options: Pap smear alone every 3 years; HPV testing alone every 5 years; or co-testing every 5 years.

However, the USPSTF is not the only group recommending cervical cancer screening. Other guidelines exist. Therefore, Pap and HPV testing happens when a woman and her health care provider review personal health, family history, and any risk factors and both agree on timing and frequency of the test.

What makes cervical cancer concerning is that it does not cause symptoms until it starts to spread beyond the cervix. Then things are pretty serious. The good news is cervical cancer rates in North Dakota are lower than the national average, as are deaths from cervical cancer. Still, nearly every year, 25 North Dakota women are diagnosed with cervical cancer and about 5 women will die from it, according to statistics from the American Cancer Society. Although some North Dakota women might feel embarrassed or scared about having the Pap test, knowing that it can save their life will hopefully encourage every woman to get their Pap smear done.

This article also appeared in the February 7, 2022 issue of the Devils Lake Journal.

About the Author

Alex McLearen is a third-year medical student at the University of North Dakota (UND) School of Medicine & Health Sciences. In addition to her participation in the UND's Indians Into Medicine Program, she was also selected as the Devils Lake participant for the school's ROME program, or Rural Opportunities in Medical Education. Because the program includes teaching student doctors about the importance of how rural newspapers can deliver health information, she has written this column for her ROME community. The information is not for diagnosis or treatment and should not be used in place of previous medical advice provided by a licensed practitioner.