IWD 2024: How to Continue Progress in Cervical Cancer Screening

International Women's Day is an opportune time to celebrate improvements in women's health outcomes-and reflect on steps we can take to achieve even more progress. For this blog, we're focusing on a specific women's health issue: cervical cancer.

Years ago, this form of cancer was one of the most common causes of cancer deaths among women in the U.S. But between 1955 and 1992, the incidence and death rates declined by more than 60%. Credit goes to the development of the Papanicolaou test-commonly known as the Pap smear or Pap test.

One of the most effective cancer screening tests available, the Pap smear helps clinicians identify cervical intraepithelial neoplasia (CIN) and remove it before it progresses to cervical cancer. The test also enables detection of cervical cancer at an early stage.

Early detection improves outcomes

When cervical cancer is detected early, the five-year relative survival rate between 2009 and 2015 was 92% for cervical cancer classified as localized by the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database. By contrast, the rate was 17% for cancers detected at the distant stage.

Despite the clear benefits of early screening, access is limited in some geographic areas or certain populations. In fact, among patients diagnosed with new cervical cancers in the United States, more than half were never screened or hadn't been screened in the five years before their diagnosis.
Add it up, and it points to a clear opportunity to implement strategies to increase access to cervical cancer screening and care. It's the most important factor for continuing to reduce cervical cancer in the United States.

Three approaches to screening

Surveying professional guidelines from the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), and the U.S. Preventative Services Task Force (USPSTF) reveals three approaches to cervical cancer screening:

1. Human papillomavirus (HPV) testing alone
2. Pap testing alone
3. HPV/Pap co-testing, which uses the same cell sample to screen for high-risk HPV types as well as cervical cell changes

These organizations recommend that most patients begin screening for cervical cancer at age 21. Patients from ages 21 through 29 should be screened every three years using a Pap test alone. Beginning at age 30 through age 65, individuals should be screened every three years with a Pap test alone, every five years with a HPV test alone, or every five years with HPV/Pap co-testing. It is important to note that these recommendations only apply to those who have no signs or symptoms of cervical cancer, regardless of their HPV vaccination status. They do not apply to those at a high risk of the disease, those with in utero exposure to diethylstilbestrol, or those with a compromised immune system.

Still, it is important to recognize that these screening methods remain imperfect tools designed not for definitive diagnoses in individuals, but for screening populations. What's more, human and systems errors can reduce their reliability, and several clinical processes-including test tracking and follow-up, accurate patient histories, and proper documentation-are important components of cervical cancer screening.

How can we support further progress?

ECRI offers these recommended actions to help build on the considerable progress already achieved in cervical cancer screening:

• Patients.Focus on educating patients about cervical cancer risks, the nature of the Pap and HPV tests as screening methods, and the importance of periodic screening. Providers need to inform patients about the current guidelines-and involve them in shared decision-making about care plans.

• Labs. There are several ways laboratories can support more effective cervical cancer screening. First, labs need to review policies and procedures for compliance with Clinical Laboratory Amendments (CLIA) regulations. Policies and procedures need to ensure that documentation of clinical history is required on requisition forms-a key step for identifying patients at high risk of cervical cancer.
  In addition, labs need to assess whether appropriate mechanisms are in place to reduce the risk of misidentifying Pap smear slides in the lab. It's also critical to ensure clear documentation and communication of lab results to the referring provider using the Bethesda System or another reporting nomenclature.
  Above all, labs need to nurture a safety culture that embraces nonpunitive reporting of problems or errors.
• Providers.Seek strategies for primary care providers to offer cervical cancer screening to individuals who have never been screened (or whose screening status is uncertain). For all patients, evaluate policies and procedures for communicating results and keeping patients who need follow-up care appropriately engaged. If they do not exist, implement a policy and procedure for notifying patients about when to have their next cervical cancer screening.

Amid global commemorations of International Women's Day, ECRI recognizes the meaningful progress in improving cervical cancer screening and outcomes. We also call for continued focus on identifying and engaging more patients for early detection and treatment.

ECRI is providing a wealth of free and shareable patient safety resources to help reduce the risks and harm to women worldwide. Access now.

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