USPSTF Issues Recommendations for Cervical Cancer Screening

Roxanne Nelson

March 14, 2012

March 14, 2012 — The US Preventive Services Task Force (USPSTF) has issued recommendations for cervical cancer screening, which were published online today in the Annals of Internal Medicine.

The recommendations are similar to those just released by the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP).

When the draft recommendations were released in October 2011, the USPSTF recommended against human papillomavirus (HPV) testing in women older than 30 years, either alone or in combination with Pap testing.

New evidence on the role of HPV testing in cervical cancer screening has since become available, and the USPSTF now recommends HPV screening in combination with Pap testing for women 30 and 65 years of age. This recommendation is now in line with that in the ACS/ASCCP/ASCP guidelines.

"We are not trying not to confuse the public," explained USPSTF chair Virginia Moyer, MD, MPH, professor of pediatrics at Baylor Medical College, Houston, Texas. "The goal is for women to get their Pap smears at appropriate intervals."

The main difference between the draft USPSTF and the ACS/ASCCP/ASCP guidelines was the recommendation on HPV testing. "After the draft came out and during the public comment, 2 new pieces of data became available," Dr. Moyer told Medscape Medical News. "Those gave us enough comfort with HPV cotesting for our recommendation."

The USPSTF now recommends cytology every 3 years, and for women 30 to 65 years of age who prefer to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years.

Same as ACS/ASCCP/ASCP Guidelines

Otherwise, the guidelines are basically the same. "The ACS/ASCCP/ASCP guidelines have more information concerning follow-up, because that is their specialty," explained Dr. Moyer. "Our focus is on the screening, and we defer to other groups on what to do once the screen is positive."

The USPSTF guidelines are meant for women with a cervix, regardless of sexual history; they do not apply those at a higher risk for cervical cancer, such as women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer, women with in utero diethylstilbestrol exposure, or women who are immunocompromised.

The recommendations are based on evidence of "both the benefits and harms of the service, and an assessment of the balance."

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone, and that clinicians need to understand the evidence but make individualized decisions for a specific patient or situation. Similarly, the USPSTF notes that "policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms."

Main Recommendations

The USPSTF recommends against screening for cervical cancer in women younger than 21 years. There is adequate evidence that regardless of sexual history, screening younger women provides no reduction in cervical cancer incidence or mortality.

They recommend against screening in women older than 65 years who have had adequate previous screening and are not otherwise at high risk for cervical cancer. There is adequate evidence that screening women in this cohort provides little to no benefit.

The guidelines recommend against screening in women who have had a hysterectomy and their cervix removed and who do not have a history of a high-grade precancerous lesion. Convincing evidence shows that screening in such women provides no benefit.

The USPSTF recommends against screening with HPV testing, alone or in combination with cytology, in women younger than 30 years. There is adequate evidence of moderate harm in this cohort.

Ann Intern Med. Published online March 14, 2012. Abstract


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