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Cervical cancer screening is one of the most significant public health accomplishments of the 20th century. Over the last 50 years, incidence and mortality rates from cervical cancer in the US have decreased by more than 50%1 because of widespread use of the Papanicolaou test and later adoption of high-risk human papillomavirus (hrHPV) testing.
Regular screening is critical in detecting disease because women with precancerous cervical intraepithelial neoplasia or early-stage cervical cancer are often asymptomatic. When detected early, 5-year cervical cancer survival is higher than 90%.1 Yet more than half of all cervical cancer diagnoses are made beyond an early stage; 37% when cancer has spread regionally to local lymph nodes and 15% when there are distant cancer metastases. Five-year survival is just 20% for women diagnosed with metastatic disease.1
Cervical cytology (Papanicolaou test) and hrHPV tests are highly effective in detecting early, more treatable disease; however, these modalities are only beneficial for women who undergo recommended screening. Unfortunately, about half of all women diagnosed with cervical cancer have never been screened or are not up-to-date on screening,2 and these women are more likely to present with regional or distant metastatic disease. Overall, approximately 1 in 4 women in the US are not up-to-date on cervical cancer screening.3 Women living in poverty or having fewer years of formal education have even lower screening rates. The direct link between screening and survival illustrates a clear and urgent need to improve cervical cancer screening rates in the US; new self-collection options approved by the US Food and Drug Administration (FDA) provide an opportunity to do so.
This JAMA Patient Page discusses screening for cervical cancer, including who should be screened, recommendations for handling positive results, and the prevention of cervical cancer.
