USPSTF Proposes Screening for Cervical Cancer with Pap Test or HPV Test, not Both
The U.S. Preventive Services Task Force (USPSTF) recently released updated draft recommendations on screening women for cervical cancer, a condition that is diagnosed in about 13,000 women and kills about 4,000 women every year in the U.S. The screening guidelines were last updated in 2012.
Under the new draft guidelines, the Task Force proposes a change in the way women ages 30 to 65 are screened. The Task Force recommends either screening with the Pap test alone every three years or screening for high-risk human papilloma virus (hrHPV)alone every five years. HPV is the virus that causes almost all cervical cancers. Previous recommendations included screening with both a Pap test and HPV testing (co-testing) every 5 years for women in this age group.
Maurine G Phipps, M.D., M.P.H., a member of the Task Force and chair of the department of obstetrics and gynecology at Women and Infants Hospital in Providence, Rhode Island, says the committee looked at the evidence on the effectiveness of different screening tests and intervals based on age and found that after age 30, the Pap test and HPV tests are both effective for cervical cancer screening. "Women ages 30 to 65, therefore, have a choice between the Pap test every three years or HPV test every five years," said Dr. Phipps.
The USPSTF guidelines have not changed for women in other age groups. Women ages 21 to 29 should be screened every three years with the Pap test. The Task Force recommends against screening women younger than 21, women older than age 65 years who have been adequately screened previously, and women at any age who have had a hysterectomy to remove their cervix.
The recommendations apply to women, regardless of sexual history, who have a cervix and have no signs or symptoms of cervical cancer. They do not apply to women who are already at high risk for cervical cancer, including those who have been diagnosed with a precancerous cervical lesion or have a weakened immune system (such as women who are HIV-positive.)
Women should be screened for cervical cancer even if they have received the full course of the HPV vaccine, which is protective against several strains of HPV. According to the Task Force report, "The overall effect of HPV vaccination on [preventing] high-grade precancerous cervical lesions and cervical cancer is not yet known. Current trials have not yet provided data on long-term efficacy; therefore, the possibility that vaccination might reduce the need for screening with cytology or hrHPV testing is not established. Given these uncertainties, women who have been vaccinated should continue to be screened as recommended until further evidence accrues."
The most recent guidelines on cervical cancer screening from other health organizations, such as the American Cancer Society, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists (ACOG), include recommendations for co-testing.
Though these organizations have yet to update their guidelines, changes may be coming. In 2016, ACOG released a statement that the use of Pap tests alone and co-testing are still specifically recommended, but screening with an initial HPV test in women age 25 years or older can be considered as an alternative. In 2015, an expert panel issued interim (temporary) guidelines saying that HPV testing may be offered to women aged 25 and older without a Pap test. (Read Experts Offer Advice on hrHPV Testing as a Primary Screen for Cervical Cancer.)
Women are advised to talk to their healthcare practitioners to make an informed decision about the tests and timing for cervical cancer screening and are strongly encouraged to get tested. Screening with HPV tests and/or Pap tests has been shown to reduce the incidence of cervical cancer as well as deaths. Over the last 40 years, deaths due to cervical cancer has declined more than 50%, primarily due to many women getting regular screenings.
"Cervical cancer is highly curable when found and treated early," said Carol Mangione, M.D., M.S.P.H., a member of the Task Force and a professor of public health at the UCLA Fielding School of Public Health. "Most cases of cervical cancer occur in women who have not been regularly screened or treated," said Mangione. "Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer."
The USPSTF has ended the comment period for the draft guidelines and, after reviewing the comments, is expected to make the new guidelines final during 2018.