The US Preventive Services Task Force (USPSTF) has issued an updated evidence summary and final recommendation statement on screening for cervical cancer.1
In its updated statement, USPSTF recommends that primary care clinicians screen for cervical cancer in women aged 21 to 29 every 3 years with cervical cytology, more commonly known as the Pap test. For women aged 30 to 65, USPSTF recommends screening with the Pap test alone every 3 years, or screening with a high-risk human papilloma virus (hrHPV) test alone every 5 years, or screening with both tests together (cotesting) every 5 years.
Women should choose which strategy is right for them after a discussion with their clinician.
Carol Mangione, MD, MSPH, University of California, Los Angeles.
“Screening for cervical cancer saves lives and identifies the condition early, when it is treatable,” says task force member Carol Mangione, MD, MSPH, of the University of California, Los Angeles, where she is chief of general internal medicine and health services research at the Geffen School of Medicine, and a professor of public health at the Fielding School of Public Health. “There are several effective screening strategies available, so women should talk to their doctor about which one is right for them.”
The recommendations apply to women with a cervix who do not have any signs or symptoms of cervical cancer, regardless of their sexual history or HPV vaccination status. The recommendations do not apply to women who are at high risk for the disease, such as women who have previously received a diagnosis of a high-grade precancerous cervical lesion.
Melissa Simon, MD, MPH, Northwestern University.
“Most cases of cervical cancer occur in women who have not been regularly screened or appropriately treated,” says task force member Melissa Simon, MD, MPH, professor of clinical gynecology, and preventive medicine and medical social sciences, at the Northwestern University Feinberg School of Medicine. “That’s why it’s important for women to be screened regularly throughout their lifetime and receive follow-up and treatment when needed.”
The task force recommends against screening in women younger than 21 years and in women older than 65 years who have had adequate prior screening. The task force also recommends against screening in women at any age who do not have a cervix. Adequate prior screening means that a woman has a history of repeated normal screening results.
USPSTF is calling for more research to evaluate whether different screening strategies could play a part in reducing deaths from cervical cancer. More research is also needed to improve follow-up for current screening strategies, and to ensure access to follow-up treatment across different populations.
Douglas K Owens, MD, Stanford University.
“We know that some populations are affected by cervical cancer more than others,” says task force vice chair Douglas K. Owens, MD, of Stanford University, where he holds professorial appointments in the school of medicine and in the international studies institute. “We need more research to determine how we can effectively reduce disparities among these women, and ultimately help save more lives.”
USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
Reference
- Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686; doi: 10.1001/jama.2018.10897.
