This week, the American Cancer Society (ACS) released updated cervical cancer screening guidelines for individuals at average risk. They now recommend that cervical cancer screening begin at age 25, instead of 21, and place a greater emphasis on human papillomavirus (HPV) testing as the preferred primary screening strategy.
“Cervical cancer is very rare in women under age 25, and most abnormalities resolve on their own at this age,” says Andrea Milbourne, M.D., professor of Gynecologic Oncology and Reproductive Medicine. “Pushing the screening age back to 25 would put the U.S. in line with the rest of the world and with our own science.”
The previous ACS guidelines recommended cervical cancer screening begin at age 21 with a Pap test every three years until age 29, then a Pap test every three years or co-testing with a Pap test and HPV test every five years from age 30 to 65.
The new ACS guidelines recommend that individuals with a cervix at average risk for cervical cancer begin screening at age 25 with a primary HPV test alone every five years. This applies to most women. Milbourne notes that HPV testing alone detects more abnormalities than Pap alone, especially in young women. The guidelines include co-testing with a Pap test and HPV test every five years or a Pap test every three years as acceptable options.
“This is the first time that HPV testing alone has been a part of the primary recommendation for cervical cancer screening, and in fact, is the preferred screening,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center.
HPV causes almost all cervical cancer cases
The new guidelines, which were last updated in 2012, come as the number of young adults vaccinated for HPV continues to rise in the U.S. According to the most recent National Immunization Survey-Teen, more than half of adolescents ages 13 to 17 have received at least one dose of the HPV vaccine. Our experts agree it’s safe and important to have your children vaccinated for HPV during the COVID-19 pandemic.
About 80% of men and women will get an HPV infection in their lifetime. Most people with HPV don’t know they’re infected and their bodies are able to clear the virus before it causes any health problems. But in some cases, the infection persists and leads to cancer. The goal of cervical cancer screening is to find cervical cancer at an early, or precancerous, stage, when the chances for successful treatment are the greatest.
Emphasis on HPV testing offers potential to reach even more women
Thanks to cervical cancer screening, cervical cancer rates have fallen by 70% in the U.S. since the 1950s, but the American Cancer Society estimates more than 13,000 new cases will be diagnosed in 2020.
“Cervical cancer is most common in underscreened and unscreened women,” Milbourne says. “Screening with a Pap test requires a visit to the doctor’s office, but making HPV testing the preferred screening method might open the door to self-screening, which might get more women screened.”
While at-home HPV testing is already promoted in other countries, including Australia, which has some of the lowest cervical cancer rates in the world, it hasn’t received Food and Drug Administration approval in the U.S. yet.
“The new ACS cervical cancer screening guidelines are the first step toward HPV testing alone being the only primary screening modality,” Bevers says. “It also carries the possibility of women eventually being able to do cervical cancer screening in the privacy of their own home and only going to the doctor for a Pap test if the HPV test is positive.”
Experts expect that convenient, at-home HPV testing could increase the number of women to receive cervical cancer screening and prevent even more cancer deaths. Studies to assess the possibility of at-home HPV testing in the U.S. are underway in early stages.
“Remember the old days of pregnancy tests? You had to go to a doctor to get one,” Bevers says. “Now you can do a pregnancy test at home and see the obstetrician only if the test is positive. These guidelines carry that possibility for cervical cancer screening in the future.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
As our patients and caregivers know, cancer doesn’t stop for COVID-19. And that means you shouldn’t stop getting your cancer screenings either.
Early on in the pandemic, you may have put off routine medical appointments, including your annual mammogram. But as cases continue to rise and we realize that COVID-19 will be with us for quite some time, you may be wondering if it’s OK to schedule routine cancer screenings, such as mammograms.
To find out, we spoke with Ethan Cohen, M.D., who sees patients at MD Anderson West Houston Diagnostic Imaging. Here are his answers to some common questions about breast cancer screening during the COVID-19 pandemic.
Is it safe to get a mammogram during the COVID-19 pandemic?
At MD Anderson, we’ve gone above and beyond to keep patients and employees safe when they’re on our campuses. For healthy women coming in for an annual mammogram, some of the key precautions include:
- Screening everyone for COVID-19 symptoms at entrances to all of our campuses.
- Providing medical face masks for everyone to wear on our campuses at all times.
- Limiting seating and spacing out appointments to allow for social distancing on campus, including in waiting and dressing rooms.
Learn more about the precautions MD Anderson is taking to protect the largest and densest population of immunocompromised patients in the world.
Why is it important for women to continue to get regular mammograms during the COVID-19 pandemic?
We know from many large clinical trials and observational studies that breast cancer screening saves lives. When breast cancer is found through screening, it’s more survivable than breast cancer found because of a lump or other symptoms. That’s because screening exams help find breast cancer at an earlier stage, when cancer is more treatable.
Most women should get an annual mammogram beginning at age 40. Women at increased risk for breast cancer may need more frequent screening, starting at a younger age more.
Is my annual mammogram covered by insurance?
Breast cancer screening is covered as a preventive service for women age 40 and older. Since January 2019, all commercial insurance providers in Texas have been required to cover digital breast tomosynthesis (DBT) – also known as a 3D mammogram – at no additional cost to patients.
What’s the benefit of a 3D mammogram?
A 3D mammogram takes multiple pictures of the breast tissue to create a 3D image of the breast. With a better image of the breast, we’re able to more accurately find and diagnose breast cancer, with less false positives. MD Anderson uses 3D technology at all four mammogram locations to ensure women are getting the most accurate results.
What’s MD Anderson doing to make breast imaging more comfortable and convenient?
We know that when women get a screening mammogram, they just want to know what’s going on as fast as possible. So, we’re now offering real-time results at our locations in West Houston, The Woodlands and League City. This means that if you’re willing to wait 5 to 10 minutes after your exam, our radiologists will read the image right then, and you’ll get the results before you walk out the door. If your results are normal, you won’t have to worry while waiting the usual three to four days to receive results. If your results are abnormal, we’ll be able to schedule any further diagnostic exams right away.
We offer mammograms at several locations throughout the greater Houston are to make it convenient for you to get your mammogram close to home:
Why should I go to MD Anderson for my mammogram?
Where you go for your mammogram matters. Not all radiologists are specifically trained in breast imaging or have extensive experience in breast imaging. At MD Anderson, our entire breast imaging team only does breast imaging, and all of our radiologists have completed a year-long fellowship, which means they’re specially trained to read breast cancer imaging. We have the latest and most precise imaging technology and protocols, a strong culture of safety and exceptional pathology expertise. This means our patients need fewer redundant scans and get a correct diagnosis the first time.
We know that when you come in for a mammogram, you may be nervous or anxious, and it helps to have a radiologist who truly cares and who has read tens of thousands of mammograms, so they know exactly what they’re looking at. Our compassionate team will be here for you when you’re going through the uncertainty of an abnormal result. And if you are diagnosed with breast cancer, we can seamlessly begin your treatment at the nation’s No. 1 cancer center.
Your risk for cancer is linked to many factors, and some people are at greater risk than others.
Certain ethnic groups and people with a family history of cancer have a higher cancer risk. So do people from sexual and gender minority groups, such as lesbian, gay, bisexual and transgender individuals.
If you are a member of the LGBT community, you can take steps to reduce your risk for cancer.
We talked to MD Anderson Training Specialist Mary-Ann Ball, who has taught thousands of MD Anderson employees about the unique cancer prevention challenges faced by members of the LGBT community.
Find a doctor you trust
The most important thing is to try your best to find a doctor you can be totally honest with. This will help you in many ways. Not only will you be able to focus more closely on your health and not on the fear of being discovered.
Your doctor will also:
- be able to collect more accurate information and tailor medical care to you,
- more clearly understand the stresses in your life and get a better picture of what you need, and
- be able to help you ensure that your partner, if you have one, is included in your health care experience.
“Once you have established a trusting relationship, many other issues can be addressed more easily,” says Ball.
Stay on top of your routine health exams
When it comes to cancer, it’s important to find the disease early, when it’s easiest to treat. And it’s important to get the right screening exams at the right age.
Screening exams may correspond more closely with your gender at birth, even if you have been through a surgical transition. So, make sure your doctor knows the full story in order to help you get the right care.
“Each piece of information, including your gender identity and sexual orientation, and where you are with any transition, is important for your doctor to know,” says Ball.
Be aware of how hormones affect your cancer risk
Hormones play a part in the development of several types of cancer. So, if you take hormones as part of a gender transition or for another reason, this can raise your risk for cancer.
Make sure that you are open with your doctor. Be aware of your body and report any symptoms early so they can be investigated.
“For example, if you are a trans man who has not gone through surgery, and your doctor doesn’t know you were a female at birth, symptoms that could be linked to a disease like uterine cancer might get overlooked.”
Get help for tobacco, alcohol and drug use
Tobacco is the leading cause of cancer-related deaths, so it’s important to get help to quit.
“Research shows that members of the LGBT community are more likely to smoke or use other forms of tobacco like e-cigarettes,” says Ball.
The best way to quit tobacco is to use medications and get counseling.
Counseling is especially important if you struggle with problems like depression and anxiety. These can become difficult to cope with if you try to quit alone.
Be aware of your body and report any symptoms early so they can be investigated.
Get the HPV vaccine
The virus is spread through sexual contact. Condoms don’t protect against HPV because it lives on the skin.
In almost all cases, the body clears HPV without any symptoms. In a small number of cases, the virus stays for longer and causes cell changes that can lead to cancer many years in the future.
Everyone is at risk for HPV, although research shows that gay men have a higher risk of getting it.
The HPV vaccine protects you from most types of the virus. Everyone ages 9 to 26 should get the HPV vaccine. It is most effective when given at ages 11 to 12. Unvaccinated men and women ages 27 to 45 should talk to their doctor about the benefits of the HPV vaccine.
Maintain a healthy weight
If you are overweight or obese, your risk for cancer is higher because the extra weight causes inflammation in your body. It also leads to hormonal changes that are linked to cancer.
The best way to maintain a healthy weight it is to eat a plant-based diet and exercise.
A plant-based diet includes vegetables, fruits, whole grains and also allows lean protein like chicken, fish and plant proteins. Fill two-thirds of your plate with plants and the remaining one-third with lean protein.
Aim to get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise every week and do a strength training routine twice a week.
Find tailored help
Finally, it may be possible to find healthy living support programs specifically designed for the LGBT community. Programs that cater to your needs and background are likely to be most effective as you work to reduce your cancer risk.
“If you can find a program that is designed for you, it will be easier for you to stay connected to the vital health care support that you need,” says Ball.
Request an appointment at MD Anderson online or by calling 1-877-632-6789
Mobile Mammography Van
MD Anderson's Mobile Mammography van provides early breast cancer detection services to women all over the greater Houston area.