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USPSTF Simplifies Cervical Cancer Screening Recommendation

Dual testing no longer needed; screening interval can be up to 5 years

The U.S. Preventive Services Task Force (USPSTF) is recommending that primary care clinicians screen for cervical cancer in women 21 to 29 years of age every three years with cervical cytology, more commonly known as the Pap test. For women 30 to 65 years of age, the USPSTF recommends either screening with cervical cytology alone every three years or screening with high-risk human papilloma virus (hrHPV) testing alone every five years.

The major change in this draft recommendation compared with the 2012 standard it would replace is that screening with hrHPV testing alone is recommended as an alternative to cytology screening alone starting at age 30 years, and co-testing is no longer recommended.

The Task Force recommends against screening women younger than 21, women older than 65 who have been adequately screened previously, and women at any age who do not have a cervix. These recommendations apply to women regardless of sexual history who have a cervix and show no signs or symptoms of cervical cancer. These recommendations do not apply to women who are already at high risk for the disease, including those who have been diagnosed with a high-grade precancerous cervical lesion or have a weakened immune system (such as women who are HIV positive).

 “Cervical cancer is highly curable when found and treated early,” says USPSTF member Carol Mangione, MD, MSPH. “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.”

“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,” says Task Force member Maureen G. Phipps, MD, MPH. “Women ages 30 to 65, therefore, have a choice between the Pap test every three years or hrHPV test every five years.”

The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at www.uspreventiveservicestaskforce.org. Comments can be submitted from September 12 through October 9, 2017, at www.uspreventiveservicestaskforce.org/tfcomment.htm.

Dr. Mangione is the Chief of the Division of General Internal Medicine and Health Services Research and the Barbara A. Levey, MD, and Gerald S. Levey, MD, endowed chair in medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). She is also professor of public health at the UCLA Fielding School of Public Health and the director of the UCLA/Drew Resource Center for Minority Aging Research/Center for Health Improvement of Minority Elderly.

Dr. Phipps is the department chair and Chace-Joukowsky professor of obstetrics and gynecology and assistant dean for teaching and research in women's health at the Warren Alpert Medical School of Brown University. In addition, she is the chief of obstetrics and gynecology at Women & Infants Hospital of Rhode Island and the executive chief of obstetrics and gynecology at Care New England.

Sources: USPSTF; September 12, 2017; USPSTF Draft Recommendation Statement; September 2017.

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