Dear Mayo Clinic: A close friend of mine recently had an abnormal result on a routine Pap test that led to a cancer diagnosis. I know cancer screenings are important, but it’s hard to keep track of which ones I should prioritise. Could you help me better understand cervical cancer screening and other screenings I should consider now?
Cancer screenings play a critical role in protecting long-term health.
They can detect cancer early, when treatment is most effective, and in some cases, help prevent cancer before it develops.
While screening recommendations vary based on age, sex, family history and personal risk factors, several key cancer screening tests should be reviewed regularly.
Cervical cancer screening is an important part of preventive care and has helped significantly reduce deaths from this disease.
It is most often caused by long-term infection with certain high-risk types of human papillomavirus (HPV).
HPV is common, and while most of these infections are cleared by a person’s immune system, other HPV infections can persist for years without causing symptoms.
People can also become infected with HPV more than once in their lifetime.
That’s why routine screening is the best way to detect abnormal changes early.
During a Pap test, a healthcare professional gently collects cells from the cervix, which is the lower part of the uterus that opens into the vagina.
These cells are examined for abnormal changes that could develop into cancer if left untreated.
The test is usually quick and can be done during a routine gynaecologic visit.
An HPV test is often done at the same time as a Pap test, using the same cell sample, and it checks for high-risk types of HPV that are most likely to lead to cervical cancer.
Cervical cancer screening does more than look for cancer.
Pap tests and HPV tests can identify precancerous changes in the cervix.
When these changes are found and treated early, cervical cancer can often be prevented.
Cervical cancer screening recommendations:
• Ages 21 to 29: A Pap test every three years.
• Ages 30 to 65: Several screening options may be appropriate, i.e. HPV test alone every five years, Pap test alone every three years, or combined Pap and HPV (called co-testing) testing every five years.
• Over age 65: Some people may be able to stop screening if they have consistently normal Pap or co-test results, and no history of severe cervical precancer.
The decision to stop cervical cancer screening should always be made together with a healthcare professional.
If a Pap or HPV test shows abnormal results, additional evaluation may be recommended.
This can include repeat testing, a colposcopy (a cervical exam done by a clinician using a special magnifying scope) or a cervical biopsy.
While abnormal results can be concerning, they often detect changes long before cancer develops, allowing for effective treatment and careful follow-up.
Screening with mammography is advised for many people beginning at midlife.
Low-dose CT (computed tomography) screening for lung cancer for those with a significant history of smoking may be appropriate every year.
Screening is recommended for most adults beginning at midlife, and sometimes earlier for those with a family history or other risk factors.
Options include colonoscopy and stool-based tests.
These screenings can detect colorectal cancer at an early stage or remove precancerous polyps before they develop into cancer.
Anal cancer is less common, but it’s also associated with HPV infection.
Routine screening isn’t recommended for the general population.
However, people with certain risk factors, such as a weakened immune system or a history of HPV-related precancers or cancers, may benefit from closer monitoring.
Symptoms, including rectal bleeding, pain, itching or a lump, should always be evaluated by a healthcare professional.
An annual visit with a primary care clinician or gynaecologist is a good opportunity to review your screening history, discuss vaccines and address new symptoms or concerns.
Keeping track of when your last Pap test, HPV test, mammogram or colorectal screening occurred can help ensure that care isn’t delayed.
Through regular screening and timely follow-up, cervical cancer is one of the most preventable cancers.
Taking a proactive approach to screenings this year can help protect health now and in the future. – Mayo Clinic News Network/Tribune News Service
Dr Jamie Bakkum-Gamez is a gynaecological oncologist in Minnesota, United States.
