Cervical cancer screening: recommendations from the USPSTF

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The major change includes screening with hrHPV testing alone as an alternative to cytology screening alone starting at age 30 years.
The major change includes screening with hrHPV testing alone as an alternative to cytology screening alone starting at age 30 years.

The US Preventive Services Task Force (USPSTF) has released a series of draft recommendations regarding cervical cancer screening in women.

The task force concluded with high certainty that the benefits of screening every 3 years with cytology alone substantially outweigh the harms in women aged 21 to 29 years and that the benefits of screening every 3 years with cytology alone or every 5 years with high-risk human papillomavirus (hrHPV) testing alone outweigh the harms in women aged 30 to 65 years.

The task force developed 4 recommendations, including one for the following groups: women aged 21 to 65, women aged 65 and older, women younger than age 21, and women who have had a hysterectomy. The recommendations apply to asymptomatic women, regardless of sexual history, and they do not apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who have a compromised immune system.

For women aged 21 to 65, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology only in women aged 21 to 29 years. The task force found evidence that screening women between ages 21 and 65 substantially reduces cervical cancer incidence and mortality. For women aged 30 to 65 years, the USPSTF recommends either screening every 3 years with cervical cytology alone or every 5 years with hrHPV testing (grade A recommendation).

For women aged 65 and older, the USPSTF recommends against screening for cervical cancer in those who have had adequate prior screening and are otherwise not at high risk for developing cervical cancer (grade D).

The USPSTF recommends against screening for cervical cancer in women younger than 21 years and in those who have had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesion (grade D).

Screening with cervical cytology or hrHPV testing can lead to harms, including more frequent follow-up testing and invasive diagnostic procedures, such as colposcopy and cervical biopsy, as well as unnecessary treatment in women with false-positive results, according to the task force. The harms for treatment for women who are not at risk for cervical cancer include risks from the treatment procedure and the potential downstream consequences of treatment.

“The major change in the current recommendation is that screening with hrHPV testing alone is recommended as an alternative to cytology screening alone starting at age 30 years, and cotesting is no longer recommended,” stated the task force. “As in the 2012 recommendation, the USPSTF continues to recommend against screening in women younger than age 21 years, in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, and in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer.”

Reference

  1. Draft Recommendation Statement: Cervical Cancer: Screening. US Preventive Services Task Force. September 2017. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2#discussion
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