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ACP strongly recommends against cervical cancer screenings in women under 21

BOSTON- During a press conference today, top American College of Physicians authorities referred to cervical cancer screenings among average-risk women under 21 as having little benefit compared to risk.

“ACP’s goal is to encourage smarter screening by telling people about the benefits and harms of screening, and encouraging them to get screened at the right time, at the right interval, with the right test,” Tanveer P. Mir, MD, MACP, board of regents, ACP, said in a press conference. 

In the Best Practice Advice for Cervical Cancer Screening in Average-Risk Women, the ACP advised against cervical cancer screenings prior to the age of 21 years. After 21, women should be screened every 3 years with cytology. In women aged 30 years and older with an average risk for the virus, a combination screening of cytology and human papillomavirus (HPV) testing should be performed once every 5 years. Prior to the age of 30, the ACP said that the chances of getting false-positive results are high.

Currently, many women are still screened for cervical cancer after the removal of the cervix, despite having a zero probability of cervical cancer, according to Robert M. Centor, MD, MACP, board of regents, ACP. The guidelines state that there is no need for cervical cancer screenings in women who have had a hysterectomy that included removal of the cervix, regardless of age. 

Robert M. Centor

The ACP advises clinicians on the potential harms of unnecessarily screening women, which include false-positive test results, pain or discomfort from speculums and colposcopies, bleeding from cervical biopsies and adverse outcomes from excisional treatments. 

It is important to remember that these guidelines apply to average-risk women, not those who are high-risk, and all screening plans should be patient-specific, according to the ACP.

“Historically, physicians have a low adherence to cervical cancer screening recommendations, so screening is initiated too early and performed too frequently,” Mir said in the conference.

Since many physicians and women are used to annual HPV and cervical cancer screenings, the update in screening times may result in some push-back. The ACP recommends that physicians inform their patients of the both the benefits and harms of screenings, so that shared decision making can occur. Mir also noted in the press conference that studies have shown women often adhere to less screening if recommended by their doctor.

Centor and colleagues said that this is a step forward towards high-value care; “improving health, avoiding harm and eliminating harmful practices.” – by Casey Hower

For More Information:

Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Presented at: ACP Internal Medicine Meeting; April 30-May 2, 2015; Boston.

 Editor's Note: On May 4, we corrected the headline to clarify that the ACP's main concern for their Best Practice Advice is to encourage smarter screenings for cervical cancer and HPV in young women. The Editors regret this error.