Health Care

New Guidelines Further Simplify Cervical Cancer Screening

New Guidelines Further Simplify Cervical Cancer Screening”

These new testing recommendations are based on evidence showing that nearly all cases of cervical cancer are caused by the human papillomavirus (HPV). In most women HPV infections resolve spontaneously, but in some the virus persists and may eventually lead to cervical cancer. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says.

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OWENS: The HPV test alone is not available everywhere, and so we want to be sure that women, no matter where they're receiving care, have options for cervical cancer screening, and the combination Pap test plus HPV test is widely available. For women who are 30 to 65, there are three very good options for them.

In 2012, 10 percent of women in the United States ages 21 to 65 years (an estimated 8 million women) reported not being screened for cervical cancer in the past five years.

The USPSTF bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. "Our biggest challenge is reaching women who have not been screened", added Melnikow, who led one of the studies on HPV testing that informed the new guidelines. It published its new recommendations in the latest issue of JAMA, the peer-reviewed medical journal.

Almost all cases of cervical cancer are caused by infection with oncogenic, or high-risk, types of HPV. Although most HPV infections clear up on their own, in some cases, the virus lingers and may eventually lead to cervical cancer. "In other words, some women will have invasive diagnostic procedures and be found to have no cervical problem". The 2018 recommendations go one step further by including, for the first time, the option of hrHPV testing alone, without a Pap test, every five years for women aged 30 to 65.

The traditional cervical cancer screening cytology test (known as the Pap test) has been in use for 75 years.

Doctors used to recommend annual Pap tests.

"It is not like you get HPV and then you get cancer", Schmeler said. Nor do they apply to women who have previously been diagnosed with cervical cancer or with a high-grade precancerous lesion, or to women who have a condition that weakens their immune system, such as HIV.

"In the USA, it's pretty rare that I see someone with advanced cervical cancer who never had a Pap", Schmeler said. Both tests collect samples in the same way.

Several other major health organizations also backed this recommendation, including the American College of Obstetricians and Gynecologists. "Although the USPSTF sets the standard for evidence-based recommendations and acknowledges the critical value of high-quality evidence in making recommendations, it might reasonably be asked, where is the evidence of value in cervical cancer screening?" wrote George Sawaya, MD, of the University of California San Francisco.

In addition, 10 years after approval of the first HPV prophylactic vaccine in the US, only 43 percent of adolescents (50 percent of girls and 38 percent of boys) were up to date with the HPV vaccination guidelines, compared with 88 percent for tetanus, diphtheria, and acellular pertussis vaccine.



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