This week’s news on cancer screening—this time on cervical cancer—isn’t nearly as controversial as last week’s, on prostate cancer, though many women might be surprised to learn that they don’t need to start screening until age 21 and might be able to stop after they turn 65.

Those are some of the conclusions of two reviews of cervical cancer screening released online today in the Annals of Internal Medicine. Both were done to help the U.S. Preventive Services Task Force, a government advisory panel supported by the Department of Health and Human Services, update its recommendations for cervical cancer screening.

One of the reviews focused on when it’s best to start and stop cervical cancer screening. Because the cancer is rare among women 20 and younger, the review says screening should start at age 21. It also concluded that women 65 or older who have a history of normal Pap smears and aren’t at high risk of cervical cancer can stop Pap smears at age 65.

The other review considered whether some kinds of Pap smears are better than others. Specifically, it compared liquid-based cytology, in which cervical cells are preserved in fluid, to the conventional Pap smear, in which the clinician collects cells from a woman’s cervix and transfers them directly to a slide for microscopic evaluation. The conclusion: while there wasn’t much difference between the two, the liquid-based test produced fewer unsatisfactory slides.

Finally, the review also considered whether, for women 30 and older, it makes sense to combine Pap smears with a test for the human papillomavirus (HPV), which contributes to cervical cancer. It concluded that while the combination does appear to offer some advantages, there isn’t yet enough evidence to recommend it for everyone.

Those recommendations more or less mirror our own. We’ve long recommended that Pap smears should start at 21. Women younger than 30 should get them every two years. Those 30 and older can get one every three years, with the option of combining it with the HPV test. And some women can stop testing entirely: Those 65 and older who have had at least three normal smears in the past 10 years; and women of any age who had their cervix removed as a result of a total hysterectomy for a noncancerous problem such as fibroids.

Sources
Liquid-Based Cytology and Human Papillomavirus Testing to Screen for Cervical Cancer: A Systematic Review for the U.S. Preventive Services Task Force [Annals of Internal Medicine]
Risk Factors and Other Epidemiologic Considerations for Cervical Cancer Screening [Annals of Internal Medicine]