Cervical Cancer Screening for Medicare

Pap Smear, HPV Test or Both?

Sample of healthy cervical cells seen on Pap smear screening. G W Willis/Oxford Scientific/Getty Images

The Centers for Medicare and Medicaid Services (CMS) recently issued recommendations regarding preventive screening for cervical cancer. Until now, CMS had advised cervical cancer screening be performed by way of a Pap smear every two years for women on Medicare, annually for women at higher risk. Now there is an option that can stretch out that screening to every five years.

About Cervical Cancer

Cervical cancer is far less common than it was in the 1940s.

Back then, cervical cancer occurred in 32 of every 100,000 American women. From 2008-2012, that number decreased to 7.7 cases per 100,000 women. The American Cancer Society estimates as many as 12,900 cases of cervical cancer in 2015 with 4,100 deaths. While cancer rates have decreased in the United States, cervical cancer remains prevalent worldwide, continuing to rank as the second most common cancer in women.

About the Pap Smear

Thanks to the widespread use of the Pap smear starting in the 1950s, deaths from cervical cancer have decreased. The test allows health care professionals to take a sample of cells from the cervix during a pelvic exam and assess them under a microscope. Cancer cells can be detected this way. Other abnormal cells, known as dysplastic cells, could also be discovered as possible precursors to cancer.

About HPV

Human papilloma virus (HPV) is a virus that has been linked to cervical cancer.

There are more than 100 strains of the virus with #16, #18, #45 and #56 being especially high risk for the development of cancer. DNA testing has been developed to look for the presence of these viruses. Similar to how a Pap smear is performed, a tissue sample is collected during a pelvic exam using a small plastic spatula or brush.

There are no blood tests available to screen for HPV.

The truth is that many women are exposed to HPV. As long as they have a normal immune system, 90 percent of women will clear these infections from their bodies within 2 years. That leaves 1 in 10 women with a long-lasting HPV infection and a high risk for cervical cancer, even if they are otherwise in good health. Women with weak immune systems or other health conditions could be at even higher risk.

Screening Recommendations

With regular screening, treatments could be offered early on in the course of the disease to kill cancer cells and/or prevent cancer from forming in the first place. Multiple medical organizations have put forth recommendations about how to best screen for cervical cancer.

The American Academy of Family Physicians (AAFP), American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS) and the United States Preventive Screening Task Force (USPSTF) all advise for the following:

  • Screening should start at age 21 years, even if a woman had been sexually active prior to that time.
  • For women 21-29 years old, Pap smear testing is recommended every 3 years.
  • For women 30-65 years old, Pap smear testing is recommended every 3 years or combined Pap smear testing with HPV testing every 5 years.
  • Any women with abnormal results would require more frequent testing.

Until now, Medicare had recommended Pap smear screening alone every 24 months. While this would account for women who do not clear HPV infections in that amount of time, it did not allow for screening of the HPV. After review of the medical literature, CMS now recommends adding the option of combined HPV testing with a Pap smear every five years for women 30-65 years of age. This could mean significantly less pelvic exams for millions of women over their lifetime. Women rejoice!


American Cancer Society. Cancer Facts and Figures 2015. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Published 2015. Accessed June 28, 2015.

Canavan TP, Doshi NR. Cervical Cancer. Am Fam Physician. 2000 Mar;1;61(5):1369-1376. http://www.aafp.org/afp/2000/0301/p1369.html

National Cancer Institute. SEER Stat Fact Sheets: Cervix Uteri Cancer. http://seer.cancer.gov/statfacts/html/cervix.html. Accessed June 28, 2015.

World Health Organization. Human papillomavirus (HPV) and cervical cancer. http://www.who.int/mediacentre/factsheets/fs380/en/ Reviewed March 2015. Accessed June 28, 2015.

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