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PCPs, internists may be overscreening for cervical cancer
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NEW ORLEANS — Frequent changes in cervical cancer guidelines may have led to overscreening among internists and primary care physicians, according to a presenter at American College of Physicians Internal Medicine Meeting.
“We’ve had different guidelines for cervical cancer over the years,” Iris Tong, MD, attending physician, Women’s Medicine Collaborative in Rhode Island and an assistant professor of medicine at The Warren Alpert Medical School of Brown University, told Healio Family Medicine.
“In the past, women were screened every year with a pap smear, then it was every 3 years with a pap smear, now with cotesting we can do screening every 5 years, so perhaps OB-GYNs and internists are screening too frequently.”
She moderated a discussion on screening, preventing and treating several women’s cancers during the meeting.
According to the panelists, the current guidelines call for cervical cancer screening in women to start at age 21, then perform a cytology every 3 years in women aged 21 to 29 years, then one of the following methods in women aged 30 to 65 years:
- cytology every 3 years
- cytology and high-risk HPV testing every 5 years (co-testing)
- high-risk HPV testing every 5 years
However, panelists said there are some caveats to these guidelines.
The recommendations are not applicable to women who have a history of immunosuppression (including HIV), history of cervical intraepithelial neoplasia grade 2+ or diethylstilbestrol exposure.
The decision to stop testing at age 65 must be preceded by three consecutive negative cytology tests or two negative cotests in the 10 years before cessation with last test conducted within the last 5 years.
The screening should continue in any woman that has a previous history of cervical intraepithelial neoplasia grade 2+ for at least 20 years following treatment.
Tong said for most women, the characteristics of cervical cancer, coupled with the screening, can lead to positive outcomes.
“Cervical cancer is a very slow growing cancer. So long as a woman is screened on a regular basis, we should be able to catch it prior to the development of cancer.” – by Janel Miller
References:
Tong I, et al. Clinical triad: Women's cancers — Screening, prevention, and treatment. Presented at: American College of Physicians Internal Medicine Meeting; April 17-21, 2018; New Orleans.
Disclosure: Tong reports no relevant financial disclosures.