New Guidelines Extend Screening Interval for Cervical Cancer

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(ChemotherapyAdvisor) – New guidelines from the United States Preventive Services Task Force (USPSTF) recommend screening for cervical cancer in women 21-65 years of age with cytology (Papanicolaou smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, a combination of cytology with human papillomavirus (HPV) testing every 5 years. The recommendations were published in Annals of Internal Medicine online March 14.

The new guidelines are generally consistent with a second set of recommendations developed independently by a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP). These guidelines were presented March 15, 2012, at the ASCCP 2012 Biennial Meeting and published in CA: A Cancer Journal for Clinicians, the Journal of Lower Genital Tract Disease, and the American Journal of Clinical Pathology.

“This is good news for women because evidence shows that an annual Pap smear is not necessary to prevent deaths from cervical cancer,” said USPSTF Chair, Virginia Moyer, MD, MPH, Professor of Pediatrics, Baylor Medical College. “Screening every 3 years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests.”

New evidence subsequent to release of a draft recommendation in October 2011 about the role of HPV testing in cervical cancer screening led to the new recommendation for HPV screening in combination with the Pap smear. The Task Force does not recommend HPV screening in women under the age of 30 years, as the infection is prevalent in younger women and often clears up on its own.

The USPSTF also recommends against screening for cervical cancer in women younger than 21 years of age, as evidence suggests such screening provides no reduction in cervical cancer incidence and mortality, regardless of sexual history.

According to the Centers for Disease Control and Prevention, women ≥30 years who have had a normal Pap result have a very low chance of getting cervical cancer in the next few years. This information supports the wisdom of extended screening intervals for cervical cancer. However, women should not skip regular check-ups.

The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer. In this population, there is high certainty that harms of screening outweigh the benefits.

Women >65 years can end screening if they have had three consecutive negative Pap smears or two consecutive negative co-tests within 10 years before cessation of screening, with the last test occurring within 5 years; however, physicians should consider screening women >65 years if never screened. Routine screening should continue at least 20 years after spontaneous regression or appropriate management of high-grade precancerous lesion, regardless of the patient's age.

“This recommendation statement does not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised (such as those who are HIV positive),” the guideline states.

The American College of Obstetricians and Gynecologists (The College) is currently reviewing the new guidelines and the data used to develop them. "Women may be worried that less frequent screening is detrimental to their overall health care needs, but this is not the case. Over-screening can lead to unnecessary treatment and could contribute to negative outcomes, such as preterm birth, in the future," said Gerald Joseph, MD, The College's Vice President of Practice Activities. "Every test has risks and benefits. As with all of our recommendations, we will evaluate the available data—including that presented in the two new reports—to determine ob-gyn practice guidelines that provide the best preventive care and treatment protocol for our patients.”

Abstract

ACS/ASCCP/ASCP recommendations, CA: A Cancer Journal for Clinicians (full-text PDF)

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