Earlier this year, the AAFP sent a letter requesting that CMS initiate a national coverage analysis (NCA) for cervical cancer screening in women ages 30-65 that would involve a combination of cytology (Pap smear) and human papillomavirus (HPV) testing every five years -- and the agency now has responded to that request in the affirmative.
Clinical Recommendations on Cervical Cancer Screening
The AAFP currently recommends cervical cancer screening with Pap smear every three years in women ages 21-65 or with a combination of Pap smear and HPV testing every five years for women ages 30-65 who want to lengthen the screening interval. The Academy recommends against screening for cervical cancer with HPV testing alone or in combination with a Pap smear in women younger than age 30. These recommendations are consistent with U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations.(www.uspreventiveservicestaskforce.org)
On Nov. 25, CMS accepted the Academy's request to begin a coverage analysis(www.cms.gov) of combined Pap smear and HPV testing every five years in women ages 30-65 as an alternative for those who want to lengthen their screening interval. Currently, Medicare covers a screening pelvic examination and Pap test for all beneficiaries at 12- to 24-month intervals depending on specific risk factors. Current coverage does not include HPV testing, even though HPV is associated with most cases of cervical cancer.
Under the Medicare Improvements for Patients and Providers Act of 2008, CMS can add coverage for "additional preventive services" if the service is recommended with a grade "A" or "B" rating by the UPSTSF. In this case, the task force gave an A ranking to its recommendation regarding combined HPV-Pap smear screening for these women, so it fits this CMS criterion.
On Dec. 17, the AAFP sent a follow-up letter to CMS praising the agency's decision to consider expanding its cervical cancer screening coverage.
"The AAFP applauds CMS for initiating this NCA and urges CMS to promptly implement policy consistent with the recommendations of the USPSTF and the AAFP," the letter notes. "Accordingly, we strongly encourage CMS to update its coverage of screening for cervical cancer, as called for in our original letter in April."
The NCA is open for public comment(www.cms.gov) until Dec. 25. CMS said it is particularly interested in comments that include published clinical studies and other scientific information to provide evidential support for improving short- and long-term outcomes related to HPV screening.
Related AAFP News Coverage
Despite Prevention Tools, Cervical Cancer Still Too Common
Don't Miss Opportunities to Screen, Vaccinate, Says FP Expert
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American Family Physician: AFP by Topic: Cervical Cancer