The American Cancer Society (ACS) has released updated guidelines for cervical cancer screening.1 Their recommendations include a switch to human papillomavirus (HPV) testing alone every 5 years for people with a cervix who are aged 25 to 65 years, moving away from recommending cytology-based screening via Papanicolaou (Pap) testing.
“HPV testing is a more sensitive test; it is going to find more pre-cancers, cancers, and more types of cancer,” said Debbie Saslow, PhD, director of Cancer Control Intervention for HPV Vaccination and Women’s Cancers for the ACS. “Pap test is okay at finding some HPV-related cancers such as squamous cell carcinoma, but the HPV test finds both squamous and adenocarcinomas,” Dr Saslow added.
The guidelines also take into account that HPV testing may not be accessible in all areas of the United States yet, so a Pap smear every 3 years is still considered acceptable in these cases, along with co-testing with both tests every 5 years. The ACS emphasized that regular testing is key.
“The value of a negative HPV test is a long-term reassurance that the person is at an extremely low risk for cervical cancer — [a] Pap test does not do much for long-term reassurance; it’s a snapshot of the situation on the day it is done,” said Dr Saslow.
The previous ACS guidelines recommended screening every 3 years via a Pap test for people aged 21 to 29 years, and there has been some criticism that the new guidelines recommended for people with a cervix who are 25 years and older might lead to some young people with cervical cancer being missed.2
“Cervical cancer in people this young is rare, but it’s not zero. There are a small number of diagnoses of cervical cancer before the age of 25, but for some reason these rare cancers don’t seem to be the typical cancers detected by screening,” said Dr Saslow, who also noted that this is an active area of research. Possible reasons include that these cancers may be exceptionally fast growing or potentially a different type of cancer from another part of the uterus that is misdiagnosed as cervical cancer.
It is hoped that growing HPV vaccination rates will result in cervical cancer case numbers tumbling in the coming years,3 but the lag time between contracting HPV and the development of HPV-related cancers is generally thought to be decades, so it will take some time before the effects of vaccination become clear.
“As more adolescents are vaccinated, the risk of developing cervical cancer — as well as head and neck, penile, and anal cancers — will drop further,” said Alexi Wright, MD, director of gynecologic oncology outcomes research at Dana-Farber Cancer Institute in Boston, Massachusetts.
Although public health experts widely expect the rates of these cancers to fall, current rates of HPV vaccination in young people are cause for concern and may present a significant barrier to further reducing the incidence of HPV-related cancers.
“The CDC estimates that 92% of HPV-related cancers could be prevented with the HPV vaccine if we achieved complete coverage. But, only 51% of teenagers ages 13 to 17 years received the recommended 2 doses of the vaccine in 2018. This is tragic,” said Dr Wright.
So although HPV vaccination rates remain a public health challenge, what will the new guidelines mean for cervical cancer detection?
“These guidelines represent progress — they reflect that fact that we are better at identifying who is at risk for cervical cancer and how to detect it. My hope is that they will reduce a lot of unnecessary [Pap] testing — and alleviate a lot of worry that frequent [Pap] testing and false-positive tests cause — but it’s still very important that all women continue to get screened,” said Dr Wright.
- American Cancer Society, Inc. The American Cancer Society guidelines for the prevention and early detection of cervical cancer. Revised July 30, 2020. Accessed September 16, 2020.
- Hologic, Inc. New cervical cancer screening guidelines from the American Cancer Society risk reversing decades of progress made against cervical cancer [press release]. Published July 31, 2020. Accessed September 16, 2020.
- Forster V. Gardasil 9 for the prevention of some head and neck cancers: measuring the benefit. Cancer Therapy Advisor. Published online August 10, 2020. Accessed September 16, 2020.