(Editor's Note: On Oct. 10, the U.S. Preventive Services Task Force announced that because of technical difficulties its website has experienced, the comment period for this draft recommendation and evidence review would be extended to 8 p.m. on Oct. 13.)
Since widespread cervical cancer screening was implemented in the United States, a dramatic drop has been seen in cervical cancer deaths. According to the most recent figures, the incidence declined from 2.8 deaths per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2014.
After reviewing data from randomized controlled trials and observational studies on cervical cancer screening, the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on the topic Sept. 12.
The USPSTF recommended primary care physicians screen women ages 21-29 every three years with cervical cytology. For women ages 30-65, the task force recommended screening with either cervical cytology alone every three years or with high-risk HPV (hrHPV) testing alone every five years. These are "A" recommendations(www.uspreventiveservicestaskforce.org).
The USPSTF also recommended against screening women younger than 21, women older than 65 who have been adequately screened previously and all women who've had a hysterectomy. These are "D" recommendations.
It's important to note that these recommendations apply to women, regardless of sexual history, who have a cervix and show no signs or symptoms of cervical cancer. The recommendations do not apply to women already at high risk for the disease, including those who've been diagnosed with a high-grade precancerous cervical lesion or have a weakened immune system (such as women with HIV-positive status).
"Cervical cancer is highly curable when found and treated early," said USPSTF member Carol Mangione, M.D., M.S.P.H., in a news release(www.uspreventiveservicestaskforce.org). "Most cases of cervical cancer occur in women who have not been regularly screened or treated. Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer."
Update of 2012 Recommendation
The only change in this draft recommendation from the USPSTF's 2012 final recommendation on the topic -- which the AAFP's 2012 final recommendation mirrored -- is that it no longer recommends women 30-65 receive both cytology and HPV testing at the same time. More recent evidence has shown that both are effective screening methods.
"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 USPSTF member Maureen Phipps, M.D., M.P.H., in the release. "Women ages 30-65, therefore, have a choice between the Pap test every three years or hrHPV test every five years."
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News there isn't a clear preference between the two screening protocols, and the choice should be based on what's available in the practice, as well as on what the patient prefers. The key is ensuring the screening takes place.
"It's important to remember that most deaths from cervical cancer in the U.S. occur in women who do not receive screening or have inadequate followup. Increasing adherence to screening will have a much greater impact on cervical cancer deaths than whether you screen with cytology or HPV," Frost said.
Evidence the USPSTF reviewed from good- and fair-quality observational studies showed hrHPV testing had a higher rate of detection of moderate or severe dysplasia (CIN2 and CIN3) than cytology, but also had more false-positive results and required more followup testing and use of colposcopy.
"There is no question about whether cervical cancer screening is effective," Frost noted. "There are, however, harms associated with screening. The USPSTF reviewed the evidence to determine which screening intervals and screening methods provide the most benefit with the fewest harms."
The USPSTF is inviting comments on its draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org). The public comment window is open until 8 p.m. EDT on Oct. 9. All comments received will be considered as the task force prepares its final recommendation.
The AAFP is reviewing the USPSTF's draft recommendation statement and supporting evidence and will provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.
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