USPSTF to advise cervical cancer screening for all women aged 21 to 65 years

Key takeaways:

• The USPSTF said women aged 21 to 29 years should receive a Pap test every 3 years.
• Women aged 30 to 65 years should receive an HPV test every 5 years or cotesting.

The U.S. Preventive Services Task Force released a draft recommendation that women aged 21 to 65 years be regularly screened for cervical cancer.

According to the task force, women aged 21 to 29 years should receive a Pap test every 3 years, while women aged 30 to 65 years should receive a high-risk HPV test every 5 years or alternatively receive aPap test every 3 years and a combined high-risk HPV and Pap test every 5 years — an approach known as co-testing.

Both recommendations are an A grade, which indicates that the task force is highly certain that the recommended services will confer a substantial net benefit.

Additionally, the USPSTF advocated against screening for cervical cancer in:

• women aged younger than 21 years;
• women aged over 65 years who have had regular screenings with normal results from their last three Pap tests or last two HPV tests, given that those tests occurred in the last 10 years and at least one test happened in the last 5 years; and
• women of any age who have had a total hysterectomy.

This recommendation, a D grade, reflects the task force’s moderate to highly certain opinion that the services will provide no net benefit or that risks of these services could outweigh possible benefits.

New updates to recommendations

The guidance aligns with the task force’s 2018 recommendations on the topic but also includes some updates. For example, it is the first time that self-collected HPV testing is included in the recommendation.

“Women who would be more comfortable collecting their HPV test sample themselves can now do so,” Esa Davis, MD, MPH, FAAFP a USPSTF member and professor of family and community medicine at the University of Maryland, said in a press release. “We hope that this new, effective option helps even more women get screened regularly.”

The USPSTF also noted it is now highlighting that HPV testing offers the best balance of harms and benefits for women aged 30 to 65 years.

“These women also have the option of getting screened with a Pap test or cotesting,” John Wong, MD, MACP, task force vice chair and a professor of medicine at Tufts University, said in the release. “That said, Pap tests continue to be the best option for women in their 20s.”

According to background information from the CDC, over nine out of 10 cases of cervical cancer are caused by HPV each year.

Testing improves precancer detection

In the evidence report, the researchers assessed 81 studies on the benefits and harms of high-risk HPV screening or uptake and accuracy of self-collected high-risk HPV tests.

They found that a single round of high-risk HPV-based screening may increase the detection of precancer vs. cytology-based screening strategies, resulting in a lower rate of precancer at a subsequent round.

The researchers additionally noted that self-collected vaginal high-risk HPV samples had similar test accuracy for precancer vs. clinician-collected cervical high-risk HPV samples and increased receipt of cervical cancer screening.

According to the task force, self-collected HPV testing could be especially helpful for women who may experience barriers accessing care or are uncomfortable with traditional screening methods.

The USPSTF said that the recommendations apply to cisgender women and everyone else assigned female at birth — like transgender men and nonbinary people — and do not apply to women at increased risk for developing cervical cancer, such as women who have HIV or a history of treatment for cervical cancer precancerous lesions.

The task force underlined that it is important women aged 65 years or older continue to be screened if they have not been screened regularly or have had abnormal results in the last 10 years.

“Most cases of cervical cancer are in women who have not been regularly screened or appropriately treated after an abnormal test result,” Wanda Nicholson, MD, MPH, MBA, USPSTF chair and a professor of prevention and community health at the George Washington University School of Medicine and Health Sciences, said in the release. “That’s why it’s so important that women get screened regularly, so cancer can be prevented or caught early when it’s treatable.”

Comments on the draft recommendation can be submitted here from Dec. 10 through Jan. 13, 2025.

References:

• Cancers caused by HPV. Available at: https://www.cdc.gov/hpv/about/cancers-caused-by-hpv.html. Accessed Dec. 10, 2024.
• Screening for cervical cancer with high-risk human papillomavirus testing: A Draft Evidence update for the U.S. Preventive Services Task Force. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/syphilis-infection-pregnant-persons. Accessed Dec. 10, 2024.
• Screening for cervical cancer: U.S. Preventive Services Task Force Draft Recommendation Statement. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/cervical-cancer-screening-adults-adolescents. Accessed Dec. 10, 2024.
• U.S. Preventive Services Task Force issues draft recommendation statement on s creening for cervical cancer. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/cervical-cancer-screening-draft-rec-bulletin_0.pdf. Accessed Dec. 10, 2024.