Somewhat new best practices in cervical cancer screening

Last week, the American College of Physicians released new practice guidelines for cervical cancer screening, which vary slightly from prior recommendations. The new guidelines are supported by the American College of Obstetrics and Gynecology and American Society of Clinical Pathologists.

The main points in the new guidelines are as follows:

  1. Women under age 21 do not need cervical cancer screening.
  2. Between ages 21 and 30, only cytologic screening is needed. No HPV testing is needed.
  3. The appropriate interval for cytologic screening for average-risk women is every 3 years.
  4. For women ages 30-65, cytologic screening plus HPV testing should be performed every 3-5 years.
  5. No HPV tests on average-risk women under age 30.
  6. After age 65, no screening is needed as long as the woman has had 3 negative cytology plus HPV screenings within the past 10 years, with at least one performed within 5 years.
  7. No screening is needed for average-risk women without a cervix.

These recommendations do not apply to women who have had a precancerous lesion, cervical cancer, are immunocompromised (e.g. HIV), and those with in-utero exposure to DES. They do not guide management of abnormal cytology or HPV results.

These guidelines are very similar to those released in 2012 by the USPSTF and ACS, though the new guidelines give HPV screening more support. The 2012 guidelines gave HPV testing a “weak” recommendation.

In contrast to many other guidelines, when it comes to cervical cancer, it appears too many patients are being screened unnecessarily. 60% of women under age 21 report having been screening for cervical cancer, as have 53% of women aged 75 to 79 years of age.

Most women will welcome the new guidelines. For those anxious about not being screened often enough, they can be reassured that the new guidelines are safe and supported by evidence.

Richard Fleming, MD

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