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USPSTF: Cervical cancer screening ‘critically important’ in saving women’s lives
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The U.S. Preventive Services Task Force today issued a draft recommendation statement and evidence review supporting cervical cancer screening among women aged 21 to 65 years.
“These guidelines emphasize that cervical cancer screening is critically important and cervical screening saves lives,” task force member Maureen G. Phipps, MD, MPH, department chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University, told HemOnc Today. “When we are able to identify cervical cancer at an early stage we are able to provide effective treatment for women. That is what I hope will be one of the critical messages from this recommendation: Women should have adequate cervical cancer screening.”
Importance of early detection
The USPSTF’s “A” recommendation advised physicians to screen women aged 21 to 29 years with cervical cytology — also known as a Pap test — every 3 years.
Women aged 30 to 65 years should undergo screening with cervical cytology alone every 3 years or with high-risk HPV testing alone every 5 years.
“The evidence shows that cervical cytology testing every 3 years or HPV testing every 5 years is effective screening,” Phipps said. “It is really about what the provider and patient have to discuss, what [screening] is available and what they feel most comfortable with.”
Compared with the USPSTF’s 2012 recommendation, cotesting with these modalities is no longer recommended.
“Both clinical trial evidence and modeling suggest that cotesting increases the number of follow-up tests by as much as twofold and does not lead to increased detection of [cervical intraepithelial neoplasia 3] or cervical cancer compared with screening with high-risk HPV testing alone,” Phipps and colleagues wrote.
The task force advised against cervical cancer screening among women aged younger than 21 years, women aged older than 65 years who have been adequately previously screened, and women with no cervix.
The task force noted these recommendations apply to women — regardless of sexual history — who have a cervix and show no signs or symptoms of cervical cancer. However, they do not apply to women who are at high risk for cervical cancer, including women diagnosed with high-grade precancerous cervical lesions or those who have weakened immune systems.
Since the implementation of widespread screening, cervical cancer deaths in the United States have decreased from 2.8 per 100,000 women in 2000 to 2.3 per 100,000 women in 2014, according to the draft recommendation
“It truly is important that women and providers are aware that cervical cancer screening is still a very important piece of preventive health for women,” Phipps said. “We have effective treatments, so if we can identify cervical cancer early, we can treat women effectively. This is critically effective to the health and lives of women.”
However, physicians should be aware of potential harms from false-positive testing — including more frequent follow-up testing, invasive diagnostic procedures, unnecessary treatment and psychological effects.
“We do look at that in terms of whether a certain testing or a certain testing interval may increase the rate of false positives, which is where the harms of overtesting or further testing may come in,” Phipps said. “Following guidelines helps to minimize those harms.”
Moving forward
The task force noted it is important for physicians to ensure women receive adequate screening, regardless of which screening method is used.
“When a patient goes in to see her physician or provider, she should talk with them about what type of cervical cancer screening she has had in the past, so that she can understand what testing she has had and at what interval, and what testing she will have in the future,” Phipps said.
Because loss to follow-up and disparities may contribute to screening participation, the task force recommended physicians have a system in place to ensure follow-up of abnormal results, appropriate treatment of any pathology, and retention of patients in the entirety of their cancer treatment.
“Physicians should be aware of the importance of cervical cancer screening and have that conversation with their patients about the need for it,” Phipps added. “Having this discussion at each of their annual visits is important so that both the patient and the provider are aware of when the next screening will come in and the importance overall of cervical cancer screening and its effect on the health and lives of women.”
Phipps also noted the importance of public comment, which will remain open through Oct. 9.
“This is a draft recommendation statement, and this is going out for public comment,” she said. “We encourage public comment because we want to make sure we are getting it right.” – by Kristie L. Kahl
Reference:
USPSTF. Draft evidence review for ovarian cancer: screening; Available at: www.uspreventiveservicestaskforce.org. Accessed on Sept. 9, 2017.
For more information:
Maureen G. Phipps, MD, MPH , can be reached at newsroom@uspstf.net.
Disclosure: Phipps reports no relevant financial disclosures.
Perspective
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Linus Chuang, MD
The new USPSTF cervical cancer screening guideline formally endorses the use of HPV primary screening every 5 years for women aged 30 to 65 years. This is in support of the American Society for Colposcopy and Cervical Pathology and Society of Gynecologic Oncology interim guideline from 2015 and 2016 and the ASCO resource-stratified cervical cancer screening guideline recommending primary screening with HPV beginning at age 25 years or older.
USPSTF admits the sensitivity is higher with HPV testing than with the Pap test but at the cost of more colposcopies needed to detect a new case of cervical cancer. The task force continues to support Pap test alone in a shorter interval of every 3 years for screening as an alternative to every 5 years with HPV primary screening. Using HPV testing alone is a big step forward compared with the recommendation of cotesting with Pap and HPV testing by American Congress of Obstetricians and Gynecologists.
Although the USPSTF guideline pushes forward the use of HPV primary screening, additional assessment is needed to determine whether HPV primary screening should begin earlier for the 25-to-30 age group to curtail rising cervical cancer incidence in this younger age group. Strategies such as self-collection of HPV DNA 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.
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