Proposed Changes to Cervical Cancer Screening Guidelines
The ACS, the ASCCP, the American Society for Clinical Pathology (ASCP), and the USPSTF have recently proposed new recommendations for prevention and detection of cervical cancer.  Importantly, the proposed revisions advise reductions in screening frequency, to maximize benefits while minimizing risks.10 These recommendations are based on evidence suggesting that annual screening does not detect cancer more effectively than screening every three years, but does place women at higher risk for vaginal bleeding, pain, infection, and missed disease.  Moreover, abnormal results may cause undue anxiety and lead to unnecessary therapy (e.g., treatment of lesions that would have otherwise regressed with time).2

Both the USPSTF and ACS-ASCCP-ASCP have drafted proposed guideline revisions, outlined in Table 3.10,13  Public feedback will be considered when developing final guidelines, which are to be released in mid-2012.2

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Table 3.  Proposed Changes to Cervical Cancer Screening Guidelines: Draft Recommendations10,13

ACS-ASCCP-ASCP Recommendations
  • All women should begin screening at 21 years of age , regardless of HPV-vaccination status
  • Women 21–29 years of age, Pap testing should be conducted every 3 years
  • Women 30 years of age and older, Pap testing should be conducted every 3 years
  • Women 30 years of age and older, combined Pap and HPV testing should be conducted every 3–5 years
  • Women aged 65 years of age and older, screening is not recommended, provided that they have had 3 or more consecutive normal Pap test results and no abnormal results in the last 10 years, or have had 2 or more negative HPV tests in the last 10 years
  • Women with normal Pap test results and a positive HPV test should undergo testing for HPV genotypes 16 and 18, or repeat Pap and HPV testing in one year; immediate colposcopy should not be performed
  • Women with mildly abnormal Pap results (ASC-US) and a negative HPV test result should undergo HPV and Pap testing or HPV testing alone at intervals of 3 or more years; immediate colposcopy should not be performed in women with discordant test results

USPSTF Recommendations

  • All women should begin screening at 21 years of age irrespective of sexual history
  • Women 21–65 years of age, Pap testing should be conducted every 3 years in those who have had vaginal intercourse and have a cervix
  • Women younger than 30 years of age, HPV testing, alone or in combination with cytology (Pap test), should not be performed
  • Women aged 30 years of age and older, due to the high rate of spontaneous clearance, there is not enough evidence to evaluate the benefits vs. risks of HPV testing, alone or in combination with Pap testing

Emerging Screening Technology: Spectroscopy
In addition to conventional screening techniques, spectroscopy may be used to identify cervical abnormalities by reflecting light changes in cervical tissue. Compared to the Pap test, spectroscopic devices offer various advantages. Namely, data are collected and analyzed in an objective fashion, thereby eliminating the potential for human error. In addition, the availability of immediate findings may enable more timely detection and management and eliminate the need to await biopsy results. Instruments may be used as an adjunct to cervical cytology, for triage after indeterminate cytology results, for localization of biopsy sites during colposcopy, or as primary screening alternatives.3

LightTouch and LuViva, two devices currently under investigation, have been shown to detect cervical disease up to two years in advance of traditional screening methods (e.g., Pap testing, HPV testing, colposcopy, biopsy).14,15 Findings revealed that LightTouch was able to detect over 86% of cervical abnormalities missed by conventional screening tests, and reduced the number of unnecessary biopsies by approximately 40%.15 Similarly, LuViva, which is under investigation for intermediary testing in women with abnormal Pap test results, was found to increase detection of CIN II/III by 20%.14 If approved for use, such devices may prove to be valuable tools for the detection and management of cervical cancer.

Topics:

Cervical Cancer Gynecologic Cancers HIV/AIDS