The U.S. Preventive Services Task Force (USPSTF) updated its screening guidelines for cervical cancer March 14, issuing final recommendations(www.uspreventiveservicestaskforce.org) that include some significant changes.
This image depicts erosion to the cervix caused by low-grade cervical carcinoma. The USPSTF recommends that women ages 21-65 be screened for cervical cancer regardless of sexual history.
The USPSTF recommends that women ages 21-65 who have a cervix have a Pap smear "every three years," which is largely consistent with its earlier position. But in the new recommendations, the task force is offering an alternative for women ages 30-65 who want to be screened less frequently. This subset now may choose to undergo a combination of Pap smear and human papillomavirus (HPV) testing every five years.
That option represents a change from the task force's previous stance, which stated that evidence was insufficient to assess the balance of benefits and harms of HPV testing, alone or in combination with cytology, for screening women 30 and older. The USPSTF did not change its recommendation against cervical cancer screening using HPV testing, alone or with cytology, in women younger than 30.
"Evidence showed that the expected harms (such as unnecessary procedures, false positives and possible problems with future pregnancies) of this screening in this (30 and younger) group outweighed the potential benefits," the USPSTF said in a press release(www.uspreventiveservicestaskforce.org).
- The U.S. Preventive Services Task Force has made its final recommendations regarding screening guidelines for cervical cancer.
- The task force recommends that women ages 21-65 who have a cervix have a Pap smear every three years, but also said women ages 30-65 now can opt for combination Pap smear and human papillomavirus testing every five years.
- The Academy is reviewing the new guidelines and will make its own recommendations at a later date.
USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., said it is also important to note that sexual history now plays no part in the decision to screen or not to screen.
"It is not factored into the age to start, age to stop or the intensity of screening," he told AAFP News Now.
The USPSTF continues to recommend against screening
- women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion,
- women younger than 21, and
- women older than 65 who previously have been adequately screened and are not at a high risk for cervical cancer.
All of the recommendations apply to women who have a cervix, regardless of sexual history, but do not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised.
According to the USPSTF release, the final recommendations are in line with those of other organizations, such as the soon-to-be-released joint guidelines from the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, as well as guidelines from the American Congress of Obstetricians and Gynecologists.
The AAFP currently is reviewing the guidelines and will release its recommendations when a determination has been made. In the interim, the Academy has added a notation to its current guidelines stating that each recommendation is "being reviewed for updating."