USPSTF simplifies cervical cancer screening recommendations: Dual testing no longer advised

The US Preventive Services Task Force (USPSTF) has issued new draft recommendations for cervical cancer screening with a major change that it recommends either cervical cytology (CC) or high-risk HPV (hrHPV) test as a screening procedure every 3 years for women aged 30-65 years, and not both ( Grade A)  

It still continues to recommend Pap screening every 3 years for women aged 21- 29 years in line with 2012 recommendations (Grade A).

Screening is not recommended in women younger than 21 years because despite their being sexually active, screening in this population subgroup does not reduce cervical cancer incidence or mortality (Grade D).

It also continues to recommend against routine screening for women aged 65 and above who had regularly undergone screening earlier and are not at high risk for cervical cancer and in women who have had a total hysterectomy with no history of cervical intraepithelial neoplasia [CIN] grade 2/3 or cervical cancer (Grade D).

These recommendations do not apply to women with in utero exposure to diethylstilbestrol, or a compromised immune system (living with HIV).

“Cervical cancer is highly curable when found and treated early,” says USPSTF member Carol Mangione, MD, MSPH. “Most cases of cervical cancer occur in women who have not been regularly screened or treated. Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer.”

“The Task Force looked at the evidence on the effectiveness of different screening tests and intervals based on age, and found that after age 30, the Pap test and hrHPV tests are both effective for cervical cancer screening,” says Task Force member Maureen G. Phipps, MD, MPH. “Women ages 30 to 65, therefore, have a choice between the Pap test every three years or hrHPV test every five years.”

The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website. It is open for public comments from September 12 through October 9, 2017.

 The American Cancer Society (ACS), American Academy of Family Physicians (AAFP), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) recommends similar screening strategy for women aged 21-29 years. 

They defer with USPSTF for age group 30-65 years of age in whom dual screening with cytology and HPV testing is advised every 5 years or cytology alone every 3 years.

ACOG also prefers cotesting with cytology and HPV testing every 5 years but  only cytology every 3 years is acceptable according to a 2016 statement.

USPSTF Draft Recommendation Statement Full Text