In 2012, the United States Preventive Services Task Force (USPSTF) updated screening recommendations for cervical cancer. According to the update, an annual Pap smear is not necessary to prevent deaths from cervical cancer. Screening for cervical cancer is recommended in women aged 21 to 65 with cytology every 3 years. Screening every 3 years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests. For women aged 30 to 65 who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years is recommended.

 “It’s important to balance benefits and potential risks associated with screening.”

The USPSTF recommends against screening for cervical cancer in women younger than age 21 and in women older than age 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer. It also recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer. Screening for cervical cancer with HPV testing, alone or in combination with cytology, is not recommended in women younger than 30.

Women who have been vaccinated against HPV infection should be screened in accordance with age-specific recommendations for unvaccinated women. Women who have an abnormal Pap test but negative HPV test can have a Pap test alone in 3 years or co-testing in 5 years. If a Pap test is negative but HPV is positive, women can be screened again with both tests in 1 year or screened specifically for HPV 16 and 18.

Balancing Benefits & Risks of Cervical Screening

It’s important to balance benefits and potential risks associated with screening. The financial implications of screening were not considered in the USPSTF recommendations. Support for less frequent screening has nothing to do with saving money. The objective of the USPSTF is to focus on the evidence relating to the benefits and potential harms of screening. Clinicians should keep these factors in mind as they review the updated USPSTF guidelines and make efforts to ensure that their patients are being screened appropriately. To facilitate these efforts, the guidelines have been made available for free from the sponsoring organizations’ websites.

References

Moyer VA. Clinical guideline: screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Mar 14 [Epub ahead of print]. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.

U.S. Preventive Services Task Force. Screening for cervical cancer: recommendations and rationale. Rockville, MD: Agency for Healthcare Research and Quality; 2003.

ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin no. 109: Cervical cytology screening. Obstet Gynecol. 2009;114:1409-1420.

Vesco KK, Whitlock EP, Eder M, et al. Screening for cervical cancer: a systematic evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 86. AHRQ Publication No. 11-05156-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2011.

Vesco KK, Whitlock EP, Eder M, Burda BU, Senger CA, Lutz K. Risk factors and other epidemiologic considerations for cervical cancer screening: a narrative review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:698-705.

Datta SD, Koutsky LA, Ratelle S, et al. Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003-2005. Ann Intern Med. 2008;148:493-500.

Castle PE, Fetterman B, Poitras N, Lorey T, Shaber R, Kinney W. Five-year experience of human papillomavirus DNA and Papanicolaou test cotesting. Obstet Gynecol. 2009;113:595-600.