October is Breast Cancer Awareness Month, and as your trusted experts in women's health, we thought it timely to inform you of some recent changes to critical women's health screening guidelines as of 2023.

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This year, the United States Preventive Services Task Force (USPSTF) announced new breast cancer screening recommendations. Importantly, they lowered the age at which women should start screening by 10 years—from 50 to 40 years old. The U.S. Food and Drug Administration (FDA) also now requires that patients are informed about the density of their breast tissue, which can impact how a mammogram is interpreted and increase their breast cancer risk.

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While you can always ask your doctor for the most up-to-date cancer screening recommendations, it’s important for women to have an idea of these timelines and guidelines for themselves too. Since they’re often changing based on the latest science and medical advancements, this can feel daunting. But don’t worry, Teal Health is here to help. 

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In this article, we’ll take a look at the latest screening recommendations for breast and cervical cancers so you can rest assured you’re on top of these important preventive measures. Note that these screening guidelines are for women with average risk factors for breast and cervical cancer. Those who have a relevant family history or may have a breast cancer-related genetic mutation may need to begin screening earlier and more frequently. You should always discuss your specific medical history with your doctor, should you need a personalized or tailored screening schedule.

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Breast cancer screening guidelines

Part of what makes screening guidelines potentially confusing is that various organizations make different recommendations. The reason the USPSTF’s updated recommendation of lowering the screening age from 50 to 40 is noteworthy is that it is now aligned with the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN). Therefore, all the major experts agree: Women should begin breast cancer screening at age 40. 

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In terms of how frequently you should get screened after your initial mammogram, the experts still differ. The ACS and NCCN state that women should get screened annually beginning at age 40, though the ACS says it should be “optional” for women ages 40-44 and mandatory from 45 onward. The USPSTF recommends women get screened every other year. In terms of what makes sense for you, talk to your doctor and come up with a plan you’re comfortable with. Weigh the pros (early detection) against the cons (like overdiagnosis or the potential for a false positive) and decide whether you’ll be screened annually or biennially. 

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As of 2023, the FDA also requires the facility conducting your mammogram to tell you about the density of your breasts. Dense breast tissue can make mammograms hard to interpret (so your provider may suggest other screening methods) and are also a risk factor for developing breast cancer.

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Most providers and the National Breast Cancer Foundation also recommend doing a breast self-exam on a regular basis (typically, once a month). Self-exams help you stay familiar with how your breasts feel, so you can notice any changes. You can start self-exams as early as your 20s and 30s. However, self-exams should not take the place of routine mammograms and clinician-conducted breast exams.

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What does breast cancer screening entail?

Breast cancer screening is usually done via a mammogram, which is an X-ray of the breast. You will place each breast between two plastic plates, and then a technician will take a quick X-ray. A screening mammogram will only take a few minutes, whereas a diagnostic mammogram (taken if you’ve noticed signs or symptoms of breast cancer) will be more involved. Other (less common) breast cancer screening approaches can involve an ultrasound or a breast MRI.

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Cervical cancer screening guidelines

As we mentioned, it can be confusing to stay up to date on all of your preventive cancer screenings. In 2018, the USPSTF made changes to cervical cancer screening guidelines. Then in 2023, the ACS released new guidelines. 

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For decades, a Pap smear was the best way to test for cervical cancer. Then, with the evidence that HPV (human papillomavirus)  causes more than 90 percent of cervical cancers, the HPV test was introduced alongside the Pap smear. Now, there are three ways to test for cervical cancer: a Pap smear, an HPV test, and a co-test, which includes both a Pap smear and HPV test. 

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The main difference between the Pap and HPV tests is that the HPV test catches changes in the cervix earlier than Pap tests. The Pap test finds changes in cervical cells after they’ve already happened. 

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Here are the most current screening schedules for cervical cancer, which include recommendations for Pap, HPV, and co-tests, according to each organization: 

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• U.S. Preventive Services Task Force: Recommends a Pap test every three years for women ages 21-29. For women over 30 years old, either a Pap test every three years, primary HPV testing alone every five years, or co-testing (Pap + HPV testing) every five years. 
• American Cancer Society: Those aged 25 to 65 should have a primary HPV test every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years. 

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The main differences between the two are recommendations based by age as well as the ACS stating HPV as the preferred type of testing. 

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What does cervical cancer screening entail?

You’ll also notice that there are three types of cervical cancer screening tests mentioned in these recommendations. Some providers continue to perform Pap smears and HPV tests together (known as a co-test) every 5 years. However, as of 2020, the American Cancer Society’s preferred cervical cancer screening method for women ages 25-65 is the primary HPV test every 5 years (in place of the Pap smear) because it is a better (more sensitive) screening test for cervical cancer. Here are the current recommendations: 

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• The Primary HPV (human papillomavirus) test screens for a panel of high-risk HPV.  Having certain HPV types is the most important risk factor for developing cervical cancer – primary HPV screening can help prevent and catch cervical cancer early. 
• The Pap test or Pap Smear The Pap test or Pap Smear looks at cells collected from the surface of your cervix.  This process can detect early changes before cancer starts, but can also show harmless changes, sometimes triggering a false positive result.
• A co-test includes the primary HPV test & the Pap test, incorporating the benefits and risks of both. This method is the runner-up to primary HPV testing in its ability to detect risks for precancer changes. 

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The procedure for these tests will look and feel the same. When you arrive at the doctor’s office, you’ll undress from the waist down and likely change into a gown. Your doctor or clinician will have you place your feet in stirrups and spread your legs. From there, they will insert and open a speculum to hold the vaginal walls apart so the clinician can access your cervix. They will insert a brush to get cells from your cervix which may cause you to feel pressure or mild cramping. It’s not a comfortable process, but it shouldn’t take longer than a couple of minutes. 

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After your exam, your clinician will insert the brush into a preservation solution and send it to a lab to perform an HPV test and/or Pap smear on the sample. You’ll typically receive results from your doctor within 1-3 weeks. 

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Now that you’re up to date on breast and cervical cancer screening guidelines, don’t wait to get screened. As for the future of cervical cancer screenings? Teal Health is working to bring you a comfortable self-collection option for cervical cancer screening that you can conveniently do in the privacy of your own home—sign up for our waitlist to be informed when we’re FDA-approved and available in your state. 

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