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New Cervical Cancer Screening Guidelines

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By Emily Lavin 

On Wednesday, March 14, 2012, a coalition of leading health groups released new cervical cancer screening guidelines that change when and how women should be tested for the disease.

The biggest change recommended by the coalition — which includes the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology — eliminates the need for an annual Pap test to screen for cervical cancer. These new recommended screening guidelines align very closely with those issued on the same day by the U.S. Preventive Services Task Force (USPSTF), an independent expert panel that advises the government on health screening guidelines.

The new guidelines tie screening options to age in an attempt to screen more effectively and prevent women from undergoing tests they don’t need. The groups found that while screening is essential, less frequent tests prevented the same number of deaths from cervical cancer as annual ones. In addition, yearly Pap tests “can lead to harm from treatment of cell changes that would never go on to cause cancer,” said Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society, in a press release issued by the ACS on Wednesday.

As stated in the ACS’s press release, the new screening guidelines are as follows:

  • Women should not be screened before age 21.
  • Women 21 to 29 should be screened with the Pap test alone (conventional or liquid-based) every three years. HPV testing should NOT be used for screening in this age group.
  • For women 30 and older, the preferred approach is the Pap test plus HPV testing (“co-testing”) every five years. Continued screening with the Pap test alone (without HPV testing) every three years is an acceptable alternative. While screening with HPV testing alone is promising, at this time it is not recommended for most clinical settings.
  • Screening is not recommended for women over age 65 who have had at least three consecutive negative Pap tests or at least two negative HPV tests in the last 10 years, with the most recent test in the last five years. Women in this age group who have a history of pre-cancer (CIN2 or a more severe diagnosis) should continue routine screening for at least 20 years.
  • Women who have undergone a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer or pre-cancer should not be screened.
  • Women who have been vaccinated against HPV should follow the age-specific recommendations in these guidelines (for unvaccinated women).

The new guidelines are not intended for women with a history of cervical cancer, exposure to DES in utero, or women who are immunosuppressed (e.g. HIV positive). Costs and other financial issues were not considered in creating the guidelines, according to the ACS.

Other new recommendations included in the guidelines are:

  • Women at any age should not be screened annually by any screening method.
  • Women with a slightly abnormal Pap test result (called “ASC-US”) and a negative HPV test can be screened again with co-testing in 5 years or with the Pap test alone in 3 years.
  • Women with a negative Pap result but a positive HPV test can either be rescreened with co-testing in one year, or tested with a test for specific types of HPV (HPV16 and HPV 18).

(Read the complete press release here.)

Currently, doctors use two methods to screen for cervical cancer — the Pap test, which can find cell changes in their early stages, and the HPV (human papilloma virus) test, which finds infections that can lead to cancer. The HPV test is rarely used alone because the HPV virus it detects often goes away on its own and doesn’t cause problems. Instead, the HPV test is used alongside a Pap test to increase early detection, or after a Pap test comes back abnormal.

It’s important to note that changes to cervical cancer screening guidelines don’t automatically mean less frequent trips to the doctor. An annual physical is still the best way to stay healthy and detect problems at their earliest stages.

The USPSTF’s recommendations were published online in the Annals of Internal Medicine on March 15, 2012, as well as on the Task Force’s web site.

 

Emily Lavin is a health writer and editor living in San Francisco.

Published March 19, 2012.

 

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