Practice Advisory: Cervical Cancer Screening

On September 12, 2017, the U.S. Preventive Services Task Force (USPSTF) released its draft cervical cancer screening recommendations and evidence review for public comment. The draft recommendations for average-risk women are listed in the following table. 

The major proposed change from the previous USPSTF recommendations is that for average-risk women aged 30–65 years, screening with high-risk HPV testing alone is recommended as an alternative to cervical cytology alone, and cotesting is no longer recommended. 

In contrast, current cervical cancer screening guidelines (1) from the American College of Obstetricians and Gynecologists (ACOG) recommend that for average-risk women aged 30–65 years, co-testing with cervical cytology and high-risk HPV testing every 5 years is the preferred approach, with cervical cytology alone every 3 years as an acceptable screening strategy. Current ACOG guidance does consider high-risk HPV primary screening to be an acceptable alternative to current cytology-based screening methods if it is performed as per the interim clinical guidance developed by the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology (2). 

The USPSTF draft recommendations for routine cervical cancer screening in women younger than 21 years, for women aged 21–29 years, and for women older than 65 years who have been adequately screened previously have not changed and remain the same as ACOG’s guidance. 

The American College of Obstetricians and Gynecologists is reviewing the USPSTF draft recommendation statement and the evidence upon which it is based to evaluate the need to update ACOG’s guidance on cervical cancer screening. In the interim, ACOG continues to affirm its current cervical cancer screening guidelines (1) and to underscore the importance of routine cervical cancer screening for women’s health. 

The Task Force draft summary of evidence and recommendations are not final, and are currently open for public comment. Please visit  www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment to submit comments to the Task Force. The public comment period is from September 12, 2017, through October 9, 2017. The Task Force will review all submitted comments and may make changes to the recommendations before the final recommendations are issued. As described, ACOG is reviewing the draft evidence review and recommendations and will submit formal comments during the public comment period. 

Please contact clinical@acog.org with any questions.

References

1. Cervical cancer screening and prevention. Practice Bulletin No. 168. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e111–30. Available at: http://journals.lww.com/greenjournal/fulltext/2016/10000/Practice_Bulletin_No__168___Cervical_Cancer.58.aspx. Retrieved September 13, 2017. 

2. Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol 2015;125:330–7. Available at: http://journals.lww.com/greenjournal/fulltext/2015/02000/Use_of_Primary_High_Risk_Human_Papillomavirus.8.aspx. Retrieved September 13, 2017. 

A Practice Advisory is issued when information on an emergent clinical issue (e.g. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. 

This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

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The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org