Cervical cancer screenings can wait until 25, says American Caner Society

ACS Issues Updated Guideline for Cervical Cancer Screening

ACS Issues Updated Guideline for Cervical Cancer Screening

In an update to cervical cancer screening guidelines, the American Cancer Society (ACS) recommends starting screenings at age 25, with primary human papillomavirus (HPV) testing as the preferred method of testing every five years through age 65. Evidence shows the HPV test is more accurate than the Pap test and can be done less often; one HPV test every five years is more effective than a Pap test every three years, and even every year as was recommended in the 1980's and 1990's, in reducing the risk of cervical cancer. In the 2012 guidelines, screening is advised upon reaching the age of 21.

"The update is based on decades of studies comparing the effectiveness of HPV testing compared to (Pap tests)", Debbie Saslow, managing director, HPV & GYN cancers with the American Cancer Society told TODAY, via email.

He added that the incidence of cervical cancer in the USA has been cut in half in the last 30 years because of widespread screening, and "an evidence-based approach to cervical cancer screening will allow us to continue to build on this progress". The guideline appears in the ACS's flagship journal, CA: A Cancer Journal for Clinicians. Those with a hysterectomy can also discontinue screening after two consecutive negative HPV tests, two negative co-tests, or three negative Pap tests done within the past 10 years - with the most recent having occurred in the past three to five years. But the HPV primary test detects the virus, which accounts for 99 percent of cervical cancers.

It is understood that few cases of HPV infection develop into cervical cancer and that progression takes many years, Smith et al noted.

Since the previous guidelines in 2012, the ACS says HPV vaccination rates have improved in the USA and has led to a drop in rates of precancerous cervical changes.

"Ideally, a screening strategy should maximize the benefits of screening by detecting precursor abnormalities that are likely to progress to cervical cancer as well as early stage cancers, while avoiding the detection of transient HPV", the authors wrote.

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While first screening at 25 instead of 21 might seem as if it might miss younger people at risk for cervical cancer, Saslow said that's not true. "My hope is that by doing the combination of vaccinating and screening and treating that will be able to eradicate (HPV-causing cancers) in this country". While screening has helped, the HPV vaccine has contributed to the decline. Dr. Wright was not part of the team that developed the updated guidelines. As the United States makes the transition to primary HPV testing, the use of cotesting or cytology alone for cervical cancer screening will not be included in future guidelines.

Individuals who are 65 and older and have had an adequate negative result in prior screening can stop getting screened.

If sufficient documentation of prior screening meeting criteria for screening cessation is not available, individuals with a cervix who are older than age 65 years, without conditions limiting life expectancy, should be screened until criteria are met.

The recommendations are transitional - i.e., while cotesting and cytology testing alone are acceptable, they should be phased out once barriers to primary HPV testing access are removed.

"Insofar as the disease burden of cervical cancer is disproportionately borne by minority and underserved populations, the unequal diffusion of a superior screening test could impede cervical cancer prevention services among medically underserved populations and further worsen health inequities", they cautioned.

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