ACS Issues Updated Guideline for Cervical Cancer Screening

Henrietta Strickland
August 1, 2020

The new guideline calls for an initial cervix screening at age 25, followed by the human papillomavirus (HPV) test every five years, continuing through age 65, the guideline says. Differences to the updated guidelines include the preferred screening strategy of primary HPV testing every five years and recommendation to start screening at age 25 years. Experts say because HPV vaccination rates have improved fewer younger women are seeing precancerous changes in their cervix. They encourage Pap tests every three years from ages 21 to 29, then co-testing of Pap test and HPV primary test from 30 to 65 every five years, or only a Pap test every three years. 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. Dr. Wright was not part of the team that developed the updated guidelines. A negative HPV test is linked to a very low cervical cancer risk.

In a statement, the ACS explained that the new guidelines reflect the need for a simplified screening process and understanding about the causes of cervical cancer and the best ways to screen for it.

"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. "But the most critical steps are boosting vaccine rates and screening". Those factors led the ACS to move the recommended age to initiate cervical cancer screening to 25. Less than 1 percent of cervical cancers are detected under age 25 - amounting to about 130 a year.

The ACS recommends that individuals with a cervix initiate cervical cancer screening at age 25 and undergo primary HPV testing every 5 years through age 65 (preferred). If primary HPV testing is not available, individuals aged 25-65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable).

One key change is a shift in favor of HPV testing (no Pap test) with a product approved by the U.S. Food and Drug Administration (FDA) for primary screening.

"The implementation of primary HPV testing for screening in all health care settings in the [U.S.] will be a major undertaking that is expected to take some time", the authors wrote.

"Giving women more certainty, with a more accurate test, can really be helpful", Wright said. These criteria do not apply to persons who are now under surveillance for abnormal screening results. The ACS recommended that individuals who don't have documentation of prior screening should continue getting screened until they have met this criteria.

"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.

Article: Fontham ETH, Wolf A, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih Y-CT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA.

The American Cancer Society (ACS) has new guidance on cervical cancer screening which intends to minimize stress and increase detection of the virus that causes it.

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