Guidelines for the early detection of cervical cancer have been updated to include recommendations on testing for and vaccination against human papillomavirus (HPV) in addition to the traditional Pap test. The updates, which revise guidelines released in 2002, were developed by leading scientists working through a collaboration of several US medical societies that includes American Society for Clinical Pathology (ASCP), the American Cancer Society (ACS), and the American Society for Colopscopy and Cervical Pathology (ASCCP). The revised guidelines are based on a systematic evidence review, contributions from six working groups, and a recent symposium cosponsored by ASCP, ACS, and ASCCP and attended by 25 organizations. The full guidelines are published in the April 2012 issue of the American Journal of Clinical Pathology.

The new screening recommendations encompass age-appropriate screening strategies, including the use of cytology (Pap test) and high-risk HPV testing alone or in combination, follow-up testing for women after screening, including the use of genotyping, and future considerations for HPV testing alone, as well as screening strategies for women vaccinated against HPV.

“This was a remarkable multidisciplinary effort that, in terms of cervical cancer screening, focused on doing what is best for women at every life stage, regardless of cost,” said Mark H. Stoler, MD, FASCP, former ASCP President and Professor of Pathology, Cytology, and Gynecology and Associate Director of Surgical Pathology and Cytopathology at the University of Virginia Health System, Charlottesville, Va. “The careful balancing of benefits versus harm, based on broadly accepted principles, has led to guidelines that are based on state-of-the-art evidence while also incorporating the collective wisdom of many experts and disciplines.”

Now scientists and physicians know that persistent cervical infection with high-risk HPV genotypes is necessary for the development of cervical cancer and its immediate precursor lesion cervical intraepithelial neoplasia grade 3 (CIN3). It is clearly the treatment of precancer (CIN3) that prevents the development of cancer, and the process that led to the revised guidelines focused on how to best identify patients with precancer who need treatment while minimizing the potential harms to patients from extensive screening.

Two types of cervical cancer screenings, the Pap test and molecular tests for HPV, often work well in tandem. The Pap test has successfully lowered cervical cancer deaths. However, false-negative results are common, and any single test is not as sensitive as previously thought for detecting CIN3. On the other hand, HPV tests are more sensitive than the Pap test for precancer and may also be better at forecasting which women will develop CIN3+ over the next five to 15 years.

For a list of recommended changes to the guidelines, click here.

Source: American Society for Clinical Pathology