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.”
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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.
Sometimes the medical world can be confusing. You may be new to a subject and are expected to make decisions that may have a big impact on your health.
That’s why it’s important to make sure you understand at least the basics of what’s going on.
We talked to Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center, about some of the terms you might come across during your screening journey.
These are terms your doctor may use. You also may see them if you are researching an exam. Some refer to tests or procedures that may follow if your cancer screening exam is abnormal.
Cancer screening terms
Adenomas: These are pre-cancerous tumors that form in gland-like cells around organs, glands and other parts of the body. They can be found in your colon with a colonoscopy. They also can develop near other glands, like the thyroid or prostate.
Biopsy: When you have a biopsy, a tissue sample is removed from a suspicious mass and examined for cancer cells. A biopsy can be done with a needle or with surgery.
Cancer screening exam: Cancer screenings are medical tests done when you’re healthy, with no signs of illness. They help find cancer early, when the chances for successfully treating the disease are greatest. You should find out what cancer screenings are right for you, based on age, gender and cancer risk.
CT scan: CT stands for computer axial tomography scan. This test uses an X-ray machine to take pictures from several angles. CT scans provide very detailed images. Some people are concerned that the ionizing radiation emitted from CT scans can harm DNA and cause tumors. But the risk associated with these tests is worth the benefit, in most cases.
Cyst: These are often described as sacks of fluid that can form anywhere in your body. Most cysts are not cancer and some go away by themselves. Others may need to be drained with a needle or removed with surgery, if they are causing troubling symptoms. Cysts are more concerning if they are found to have a mass inside them.
Dense breasts: If you have dense breasts it means you have more glandular tissue, like breast and connective tissue, than fat. Breast density can only be determined by a mammogram. You can’t tell by feel or by size or firmness.
False-positive/negative: A false-positive result is when your screening exam shows there is a problem when actually there is not. False negatives are when your test shows there is no problem when actually there is something wrong. False-positive results are far more common than false-negative results. The more cancer screening exams you have, the more likely you are to get a false-positive result at some point. But in most cases, doctors say the benefits of screening still outweigh the risk that your result may be incorrect.
Genetic testing: Genetic testing involves analyzing a blood sample for specific changes in the DNA, or genetic information. The results help your doctor find out if you are more likely to get cancer because of an inherited genetic mutation like the BRCA mutation. Not everyone needs genetic testing. Only 5-10% of cancers are related to genetics. The decision to get tested is usually based on your family medical history. Learn more about whether you might need genetic testing for cancer.
Lesion: This is an area of abnormal tissue. It often appears like a sore and can be found on any surface inside or outside your body. For example, a dermatologist may find a lesion on your skin, or one could be found during a colonoscopy. Lesions can be benign or malignant.
Lymph node: The lymph nodes are part of the lymphatic system, which is the body's infection-fighting system. Your body has many lymph nodes, mainly in the neck, armpit, torso and groin. Tumors can develop in the lymph nodes or tumors elsewhere in your body can spread to the lymph nodes.
Mass: A mass is a lump in your body. You may be able to feel or see it through your skin, or it may only be detectable with a screening exam. A mass that is not cancer is called benign. If a mass is cancerous, it is called malignant. These lumps have several causes including fluid build-up, abnormal cell growth, hormonal changes or the body’s response to infection or inflammation. If a mass is found, it will likely lead to more testing.
MRI: MRI stands for magnetic resonance imaging. This test uses magnetic fields and radio waves to generate pictures of your body’s soft tissue and organs. Your health care professional will examine the images for possible problems. You may have to drink fluid called contrast before the exam to help make the images clearer.
Needle biopsy: These are a biopsies that are done with needles. It could be a fine needle aspiration, which is done with a long thin needle. Or it could be a core needle biopsy where a thicker needle is used. In each, the needle is inserted directly in the suspicious area to draw out samples for examination.
Overdiagnosis: This is when a problem is found in a screening exam and more testing finds a cancer that is so slow-growing that it is not harmful to the patient. Overdiagnosis also can mean a cancer is found that would have resolved on its own. Both cases are a problem because they can lead to unnecessary treatments that might put a patient at risk. A good example of this is the PSA test for prostate cancer. Many tumors are found that would never pose a threat to the patient. This is why MD Anderson recommends men talk to their doctor about best practices for using this test before they start screening.
Polyp: A polyp is a small growth that may turn into cancer. Polyps come in different shapes and sizes and are most common in adults age 50 and older. An example is a colon polyp found inside your colon. These polyps are found through colonoscopy, the gold standard test for colorectal cancer. If your doctor finds a polyp during a colonoscopy, they can remove it during the exam. Polyps also can be found in other places and are often harmless, like nasal polyps.
Precancerous cells: These cells have started to show the first signs of DNA mutations that can lead to cancer. If precancerous cells are found, your doctor might call it stage 0 cancer or carcinoma in situ. The cells may become cancer and spread to nearby tissue.
Precancerous lesion: A precancerous lesion is a collection of precancerous cells found somewhere visible. This can be on the skin, in the mouth or inside your colon or rectum. If you have precancerous lesions, a physician may tell you that you have dysplasia.
X-ray: X-rays are the most common way doctors get images of the inside of the body. They use low doses of high-energy radiation that travel through the body. X-rays are referred to as radiography. Radiologists can spot abnormal areas in X-ray images that may indicate the presence of cancer.
Mobile Mammography Van
MD Anderson's Mobile Mammography van provides early breast cancer detection services to women all over the greater Houston area.