Women ages 21 to 65 should be screened regularly for cervical cancer (A recommendation), but women ages 30 to 65 can be screened either via a Pap smear every 3 years or via human papillomavirus (HPV) molecular testing every 5 years, said the U.S. Preventive Services Task Force.
For women ages 30 to 65 with a cervix, the USPSTF recommended with high certainty that the benefits of cervical cancer screening through either cervical cytology alone every 3 years or high-risk HPV testing alone every 5 years outweigh the harms.
Younger women ages 21 to 29 with a cervix should be screened for cervical cancer with cervical cytology alone every 3 years. Screening is not recommended for women under age 21, those with a hysterectomy, or those over age 65 with adequate prior screening and not at risk for cervical cancer (D recommendation).
These draft recommendations were published on the , where comments may be submitted.
Recommendations for women ages 30 to 65 are the only update from the prior 2012 recommendations, which previously stated that these women should receive cervical cytology and high-risk HPV testing at the same time.
"The Task Force 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 hrHPV tests are both effective for cervical cancer screening," said Task Force member Maureen G. Phipps, MD, in a statement.
Characterizing both cytology alone and high-risk HPV testing as offering "a reasonable balance" between benefits and harms, the USPSTF said women should discuss which screening strategy is most appropriate for them. Each test has its own pros and cons -- while that screening with cytology alone may be "slightly less sensitive for detecting CIN2 and CIN3" than high-risk HPV testing, the latter requires more diagnostic colposcopies for each case detected.
"False-positive rates are higher among women younger than age 30 ... because of the higher incidence of transient HPV infection in younger women, even though cervical cancer incidence is lower in this age group," the Task Force wrote.
They added that evidence from both good- and fair-quality observational studies found that high-risk HPV testing and co-testing has a higher sensitivity, but lower specificity. In addition, co-testing "increases the number of follow-up tests" by as much as twofold and does not lead to increased detection of CIN3+ (CIN3 and all invasive cancers), so "the USPSTF did not include co-testing in this recommendation statement."
These new recommendations do not apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer, who had in utero exposure to diethylstilbestrol or have a compromised immune system (such as women living with HIV). The authors noted they are similar to interim guidance developed in part by the American Society of Cytopathology and the Society for Gynecologic Oncology in 2015, recommending primary HPV screening starting at age 25, as an alternative to cytology or co-testing.
Linus Chuang, MD, of Icahn School of Medicine at Mount Sinai, who was not involved with the research, said these recommendations represent "a big step forward" in using HPV testing as a primary screening method for cervical cancer. In a statement, he added that "strategies such as self-collection of HPV DNA" should be explored in the future, given that nearly half of women with cervical cancer in the U.S. had no cervical cancer screening in the past 5 years.
Public comment on this recommendation statement will be accepted until October 9, 2017.
Primary Source
U.S. Preventive Services Task Force
US Preventive Services Task Force "Screening for cervical cancer: U.S. Preventive Services Task Force draft recommendation statement" USPSTF 2017; Published September 12, 2017.