New USPSTF Draft Recommendation on Cervical Cancer Screening

Posted on October 02, 2017

Dr. Anna Camille Moreno discusses the new U.S. Preventive Services Task Force's recommendation on cervical cancer screening.

The U.S. Preventive Services Task Force (USPSTF) has issued new draft recommendations for cervical cancer screening in low risk women, updating their 2012 recommendations. This creates some variation among guidelines published in 2015 by representatives from seven specialty societies including:

• American College of Obstetricians and Gynecologists (ACOG)
• American Society for Colposcopy and Cervical Pathology (ASCCP)
• American Cancer Society (ACS)

Draft: Recommendation Summary

This is a Draft Recommendation Statement. This draft is distributed solely for the purpose of receiving public input.

5 Cervical Cancer Screening Recommendations

1. Recommends screening for cervical cancer every 3 years with cervical cytology alone in women ages 21 to 29 years. (A Recommendation)
2. Recommends either screening every 3 years with cervical cytology alone or every 5 years with high-risk human papillomavirus (hrHPV) testing alone in women ages 30 to 65 years. (A Recommendation)
3. Recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D Recommendation)
4. The USPSTF recommends against screening for cervical cancer in women younger than age 21 years. (D Recommendation)
5. The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. (D Recommendation)

The first four recommendations apply to women who have a cervix, regardless of their sexual history or HPV vaccination status as well as other risk factors, such as:

• Age of first sexual intercourse
• Number of sexual partners
• History of other STIs

None of these recommendations apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer. These recommendations also do not apply to women with in utero exposure to diethylstilbestrol or women who have a compromised immune system (women living with HIV).

New Recommendations To Pay Attention To

What is new that has raised some discussion is what the USPSTF mentions in its “Clinical Considerations” section. The USPSTF recommends either screening every 3 years with cervical cytology alone or every 5 years with high-risk human papillomavirus (hrHPV) testing alone in women ages 30 to 65 years. The USPSTF did not include cotesting in this recommendation statement.

Why The New Recommendations?

Screening with cytology alone is slightly less sensitive for detecting CIN2 and CIN3 than screening with hrHPV testing alone, whereas screening with hrHPV testing alone detects more cases of CIN2 and CIN3.

Advantages of New Recommendations:

1. Less diagnostic colposcopies: cotesting increases the number of follow-up tests by as much as twofold and does not lead to increased detection of CIN3+ (CIN3 and all invasive cancers) or cervical cancer compared with screening with hrHPV testing alone.
2. Less follow-up testing for average-risk women: cotesting increases the number of follow-up tests by as much as twofold and does not lead to increased detection of CIN3+ (CIN3 and all invasive cancers) or cervical cancer compared with screening with hrHPV testing alone.
3. Cost-effective

Disadvantages of New Recommendations:

1. Pap cytology can detect NON neoplastic findings: keratotic changes, atrophy, squamous metaplasia – may even have specimens such as trichomonas, fungal infections “shift in flora” c/w BV, cervicitis, inflammation

It’s important to talk to your women’s health provider about cervical cancer screening. Initial screening to identify high-risk women is key. This is important because it is estimated that 10% of women with cervical cancer had inappropriate follow-up and 50% of women with cervical cancer were never screened in addition to the 10% who had not been screened within 5 years of diagnosis.

You become in charge of your health when you keep up with the evidence and the guidelines!

Anna Camille Moreno, DO NCMP

Dr. Moreno is an assistant professor and medical director of the Midlife Women's Health program at University of Utah OBGYN. Her focused training includes midlife care involving perimenopause, menopause, hormone therapy, bone health (osteoporosis management and treatment), sexual dysfunction, vulvar disorders, and genital chronic graft versus host disease. She is also a medical consultant and a freelance medical writer for GoodRx, Inc. Dr. Moreno is a graduate of the Specialized Women's Health Fellowship Program at Cleveland Clinic.