On Aug. 21, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on screening for cervical cancer.
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, high-risk HPV (hrHPV) testing alone every five years, or hrHPV testing in combination with cytology (co-testing) every five years. These are "A" recommendations.(www.uspreventiveservicestaskforce.org)
The task force also recommended against screening women younger than 21, women older than 65 who previously have been adequately screened, and women who've had a hysterectomy with removal of the cervix and who have no history of a high-grade precancerous lesion or cervical cancer. These are "D" recommendations.
It's important to note that the first three recommendations apply only to individuals who, regardless of sexual history, 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 who have a weakened immune system (such as women with HIV infection).
- The U.S. Preventive Services Task Force 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, high-risk HPV (hrHPV) testing alone every five years, or hrHPV testing in combination with cytology every five years.
- The task force also recommended against screening women younger than 21, women older than 65 who previously have been adequately screened and certain women who've had a hysterectomy.
"Screening for cervical cancer saves lives and identifies the condition early, when it is treatable," said USPSTF member Carol Mangione, M.D., M.S.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "There are several effective screening strategies available, so women should talk to their doctor about which one is right for them."
The task force called for more research to evaluate whether different screening strategies could further reduce deaths from cervical cancer; it said more research is needed to improve follow-up for current screening strategies and to ensure access to follow-up treatment across different populations.
"We know that some populations are affected by cervical cancer more than others," said USPSTF Vice Chair Douglas Owens, M.D., M.S., in the release. "We need more research to determine how we can effectively reduce disparities among these women, and ultimately help save more lives."
This final recommendation statement updates the USPSTF's draft recommendation from Sept. 12, 2017, and the task force's 2012 final recommendation, which the AAFP supported at that time.
The new final recommendation updates the draft version by adding back in a recommendation option from the 2012 guidance for co-testing every five years with hrHPV testing and cytology.
The draft version of this final recommendation statement was posted for public comment on the task force's website from Sept. 12, 2017, through Oct. 13, 2017.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News the AAFP's Commission on Health of the Public and Science (CHPS) reviewed the USPSTF's draft recommendation statement and draft evidence review for cervical cancer screening and provided extensive comments during this period, including expressing concern about removing co-testing as an option.
"The USPSTF takes the comments of stakeholders seriously, and I was pleased to see that they made important changes that address the concerns shared by the AAFP," she said.
The task force said some of the commenters requested clarification on the differences between co-testing and primary hrHPV testing. Other respondents explained that there would be issues with implementing primary cervical cancer screening recommendations because of a lack of available FDA-approved tests.
In addition to adding the co-testing recommendation back in, the USPSTF responded to commenters by providing a table in the "Clinical Considerations" section(www.uspreventiveservicestaskforce.org) that presents detailed information about the available evidence on the effectiveness, strengths, limitations and unique considerations of each screening method.
Also, to further answer questions raised about the modeling study included, the task force added calibrated input parameter values, which, it said, "should enable informed readers to assess the estimates used."
Finally, the USPSTF added language throughout the final recommendation statement to emphasize several factors that affect overall screening effectiveness, including the primary screening test, screening ages, screening interval, test characteristics and follow-up protocols, including triage of screen-positive women.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence review and determine the Academy's stance on the recommendation.
Frost noted that since the advent of widespread screening, the incidence of cervical cancer has markedly decreased.
"The majority of cases of cervical cancer occur in women who have not been adequately screened," she said. "The message to family physicians is that screening for cervical cancer significantly decreases the incidence of and mortality from cervical cancer. The decision about how to screen -- using cytology, co-testing or primary HPV -- will depend on their resources and patient preference."
Related AAFP News Coverage
USPSTF Offers Updated Cervical Cancer Screening Regimen
Draft Recommendation Includes New Protocol for Women 30-65