News

After Age 30, Cervical Ca Screening Intervals Extended

View on the News

Frequent Screening Risky

"Screening tests can unintentionally cause significant harm," Dr. Nora Kizer and Dr. Jeffrey F. Peipert said in an accompanying editorial. This harm includes misdiagnoses, unnecessary tests, and unnecessary procedures.

In addition to the USPSTF guidelines, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology (ACS/ASCCP/ASCP) recently have published cervical cancer prevention guidelines that similarly extend the intervals between screenings, they noted.

"Health care providers and patients may be reluctant to adopt the longer screening intervals recommended in the new guidelines. We believe it is paramount for health care providers to take the initiative in fostering this change and acceptance. More frequent screening than recommended not only offers no benefit, but it can cause harm," they said. "Health care providers should welcome the new recommendations with enthusiasm and incorporate them into routine clinical practice."

There are slight differences between the USPSTF and the ACS/ASCCP/ASCP guidelines for women aged 30- 65 years, said Dr. Kizer and Dr. Peipert.

"The ACS/ASCCP/ASCP recommendations state that the preferred method of screening is cytology with HPV testing (‘cotesting’) at 5-year intervals. Use of cytology at 3-year intervals is also ‘acceptable,’ especially if access to HPV testing is not practical. The USPSTF guidelines state that both methods provide similar benefits and advocate cotesting as an option for those women who desire to lengthen the screening interval.

"The ACS/ASCCP/ASCP guidelines also note that there is insufficient evidence to change screening intervals in this age group following a history of negative screens," they said.

Also, the ACS/ASCCP/ASCP guidelines recommend that women who have received the HPV vaccine should continue to be screened, they added.

Although more research is needed on how to modify screening in different risk groups, said Dr. Kizer and Dr. Peipert, "overall, the new recommendations from the USPSTF and ACS/ASCCP/ASCP regarding cervical cancer screening are compatible and appropriate."

Dr. Kizer and Dr. Peipert are members of the department of obstetrics and gynecology at Washington University, St. Louis. Dr. Kizer and Dr. Peipert said they had no relevant financial disclosures. They commented in an editorial accompanying the USPSTF task force report (Ann. Intern. Med. 2012;156 [Epub ahead of print 15 Mar 2012]).


 

FROM ANNALS OF INTERNAL MEDICINE

Women aged 30-65 years can extend the interval between Pap smears from 3 years to 5 years if they get tested for human papillomavirus at the same visit, according to new guidelines from the United States Preventive Services Task Force published online March 14 in Annals of Internal Medicine.

Women aged 21-29 years should still be screened every 3 years, as should women aged 30-65 years who do not undergo an HPV test concurrently with a Pap test for cervical cancer. The guidelines apply to all women with a cervix, regardless of their sexual history.

The United States Preventive Services Task Force (USPSTF) released a draft recommendation for cervical cancer screening guidelines in October 2011, but new evidence about the role of HPV testing in cervical cancer screening has since become available, and this evidence informs the newest guidelines for combining HPV and Pap tests for women aged 30-65 years, according to the task force (Ann. Intern. Med. 2012;156 [Epub ahead of print 15 Mar 2012]).

"We try to update our recommendations at least every 5 years and sooner if new evidence is available. In this case, it had been longer than 5 years since the last update and new evidence was available," task force chair Dr. Virginia Moyer said in an interview.

"Our recommendations, as well as those from other organizations, make it clear that more frequent screening than every 3 years for Pap alone or every 5 years for cotesting is not necessary and is associated with additional harms without significant additional benefit," said Dr. Moyer, professor of pediatrics at Baylor College of Medicine in Houston.

"We want to emphasize that in terms of saving lives, encouraging screening among women aged 21-65 years who have not been screened or have not been screened in the last 5 years is where the greatest benefit will accrue," she said.

The new guidelines replace those issued by the USPSTF in 2003, which called for annual cervical cancer screening for women starting at age 21 years or within 3 years of the onset of sexual activity.

The new recommendations also reduce the frequency of cervical cancer screening compared with guidelines issued by the American College of Obstetricians and Gynecologists in 2009. The 2009 ACOG guidelines called for cervical cancer screening every 2 years for women aged 21-29 years and every 3 years for women aged 30 years and older, as long as they had no history of cervical intraepithelial neoplasm (CIN) 2 or 3, HIV infection, in utero exposure to diethylstilbestrol, or immunocompromise.

The new guidelines also state that women who have had hysterectomies that involve removal of the cervix and have no history of cervical cancer or precancerous lesions can discontinue screening, as can women older than 65 years who have had three consecutive negative Pap tests or two consecutive negative Pap tests/HPV tests within 10 years before discontinuing screening, with their last test occurring within 5 years. However, the task force noted that clinicians should consider cervical cancer screening for women older than 65 years who have not had a hysterectomy and have never been screened.

The task force does not recommend cervical cancer screening for women younger than 21 years, and does not recommend cervical cancer screening using HPV (alone or in combination with a Pap smear) in women younger than 30 years, because of the high prevalence (and high rate of resolution) of HPV in younger women.

However, "It is well established that HPV infection is associated with nearly all cases of cervical cancer," the task force noted. "There is an emerging chain of evidence suggesting that HPV testing followed by cytology in women with positive HPV tests may also be a reasonable screening strategy," they said.

The new guidelines state that more research is needed to continue to assess the effectiveness and potential harm of different cervical cancer screening strategies, including HPV testing and Pap testing alone, in combination, or sequentially. However, in women aged 30-65 years, "evidence was adequate to conclude that the potential benefit of HPV testing in combination with cytology every 5 years is comparable with the benefits achievable with cytology alone every 3 years," according to the guidelines.

Disclosures of USPSTF task force members were not available at press time.

Recommended Reading

VEGF-Targeting Cancer Drugs Raise Risk of Fatal Side Effects
MDedge Hematology and Oncology
Cancer Deaths in Europe Still Declining
MDedge Hematology and Oncology
Limit Aspirin for Cancer Prevention to Patients Aged 55-75
MDedge Hematology and Oncology
Off-Label Use of Aprepitant Quells Refractory Pruritus
MDedge Hematology and Oncology
Estrogen Protects Against Breast Cancer Long After Treatment
MDedge Hematology and Oncology
Can a Biomarker Revive Everolimus for Advanced Gastric Cancer?
MDedge Hematology and Oncology
Circumcision May Lower Prostate Cancer Risk
MDedge Hematology and Oncology
Infants Left Out of Survival Gains in Childhood Leukemia
MDedge Hematology and Oncology
Genetic Testing Makes Slow, But Steady, Growth
MDedge Hematology and Oncology
Exposure to Diesel Exhaust Tied to More Lung Cancer Deaths
MDedge Hematology and Oncology