NEW GUIDELINES FOR CERVICAL CANCER SCREENING

The US Preventive Services Task Force (USPSTF) has issued new draft recommendations for cervical cancer screening.

The major change from their 2012 recommendation is that testing for high-risk strains of human papillomavirus (hrHPV) alone is now recommended as an alternative to cytology or Papanicolaou (Pap) screening alone beginning at age 30 years; cotesting is no longer recommended.

As in the 2012 recommendation, the USPSTF continues to recommend that women aged 21 to 29 years undergo Pap screening every 3 years.

They recommend against screening in women younger than age 21 years because there is adequate evidence that regardless of sexual history, screening younger women does not reduce cervical cancer incidence or mortality.

The USPSTF also continues to give a thumbs down to screening in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, as well as in women who have had a hysterectomy and their cervix removed and do not have a history of a high-grade precancerous lesions or cervical cancer.

 "Cervical cancer is highly curable when found and treated early," says Task Force member Carol Mangione, MD, MSPH, in a statement. "Most cases of cervical cancer occur in women who have not been regularly screened or treated. Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer."

Most cases of cervical cancer occur in women who have not been regularly screened or treated. Dr Carol Mangione

None of these recommendations apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cancer, were exposed to diethylstilbestrol in utero, or have a compromised immune system.

The draft recommendation statement and draft evidence review are posted for public comment on the Task Force website. The public comment period is open through October 9, 2017.

Change in Guidelines

The guidelines for women aged 30 to 65 years were changed because the existing literature shows that screening with cytology alone and hrHPV testing alone "offer a reasonable balance between benefits and harms" in this age group.

Modeling and clinical trial evidence also suggest that cotesting nearly doubles the number of follow-up tests and does not lead to increased detection of cervical intraepithelial neoplasia 3+ or cervical cancer as compared with screening with hrHPV testing alone.

The recommendations are similar to those of the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) for women aged 21 to 29 years. For those 30 to 65 years, they recommend screening every 5 years with cytology and HPV cotesting or screening every 3 years with cytology alone.

Guidelines from the American Academy of Family Physicians' guidelines agree with those from ACS/ASCCP/ASCP.

The American College of Obstetricians and Gynecologists (ACOG) says that cotesting with cytology and HPV testing every 5 years is preferred, but screening with cytology alone every 3 years is acceptable.

An Expert Comments

In a statement, Linus Chuang, MD, professor of obstetrics, gynecology and reproductive science, Icahn School of Medicine at Mount Sinai in New York City, said that this update "formally endorses the use of HPV primary screening" at 5-year intervals in women aged 30 to 65  years.

Dr Chuang, who was not involved in the guidance development, said that the USPSTF recommendations also support the ASCCP and Society of Gynecologic Oncology interim guideline from 2015 and 2016 and the American Society of Clinical Oncology resource-stratified cervical cancer screening guideline, which calls for primary HPV screening beginning at 25 years or older.

"Strategies such as self-collection of HPV DNA as a strategy should be explored in the future as nearly half of the women with cervical cancer in the United States have not received any cervical cancer screening in the past 5 years," he noted.