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Practice Advisory: Cervical Cancer Screening (Update)


The Society of Gynecologic Oncology and ASCCP endorse this document.

On August 21, 2018, the U.S. Preventive Services Task Force (USPSTF) published its final recommendation statement (1) on cervical cancer screening in average-risk women (Table 1).

 


Table 1. 2018 USPSTF Cervical Cancer Screening Recommendations for Average-Risk Women



Abbreviation: hrHPV: high-risk human papillomavirus.

*These recommendations apply to women with a cervix who do not have any signs or symptoms of cervical cancer, regardless of their sexual history or human papillomavirus vaccination status. These recommendations do not apply to women who are at high risk of the disease,   
such 
as women who have previously received a diagnosis of a high-grade precancerous cervical lesion. These recommendations also do not apply to individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (eg, women living 
with 
human immunodeficiency virus).

Grade A denotes that “The USPSTF recommends the service. There is high certainty that the net benefit is substantial.” A Grade D definition means that, “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that        the harms outweigh the benefits.” For more information on the USPSTF grades, see https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions

Testing should be performed only to detect the presence of high-risk HPV. There is no role for testing for low-risk genotypes, and tests for low-risk HPV should not be performed.

Data from Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. US Preventive Services Task Force. JAMA 2018;320:674–86. Available at: https://jamanetwork.com/journals/jama/fullarticle/2697704. Retrieved August 24, 2018


The major change from the 2012 USPSTF guidelines is that for average-risk women aged 30–65 years, the USPSTF now recommends high-risk human papillomavirus (hrHPV) testing alone every 5 years as an alternative to screening with cervical cytology alone every 3 years or screening with a combination of cytology and hrHPV testing every 5 years. The new USPSTF recommendation is based on a review of data from clinical trial, cohort, and modeling studies (1). 

The USPSTF recommendations are largely in line with current cervical cancer screening guidelines from the American College of Obstetricians and Gynecologists (ACOG) (2); ASCCP; the American Cancer Society; and the American Society for Clinical Pathology (3); and interim clinical guidance on hrHPV testing developed by an expert panel that included representatives from the aforementioned groups, the Society of Gynecologic Oncology, the American Society of Cytopathology, and the College of American Pathologists (4). Like the USPSTF recommendations, these expert guidelines recognize that cytology alone, hrHPV testing alone, and co-testing are all effective screening strategies for average-risk women aged 30–65 years. However, expert guidelines recommend that for these women, co-testing with cervical cytology and hrHPV testing every 5 years is preferred, screening with cervical cytology alone every 3 years is acceptable, and hrHPV testing alone can be considered as an alternative screening strategy (4).

The USPSTF 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 (2).  

The new USPSTF recommendations emphasize that the choice of screening strategy should consider the balance of benefit (disease detection) and potential harms (more frequent follow-up testing, invasive diagnostic procedures, and unnecessary treatment in women with false-positive results) and involve shared decision making between patients and their health care providers. Because inadequate cervical cancer screening remains a significant problem in the United States, it is critical that all women have access to cervical cancer screening, regardless of specific strategy. 


ACOG will review the USPSTF’s final recommendation statement and supporting evidence to determine the need to update its clinical guidance on cervical cancer screening. In the interim, ACOG affirms its current cervical cancer screening guidelines (2), which encompass all three cervical cancer screening strategies (cervical cytology alone, hrHPV testing alone, and co-testing). It is appropriate to counsel average-risk women aged 30– 65 years regarding all three strategies so that they can select their preferred option.


References

  1. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. US Preventive Services Task Force. JAMA 2018;320:674–86. Available at: https://jamanetwork.com/journals/jama/fullarticle/2697704. Retrieved August 24, 2018. 

  2. 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 August 24, 2018.

  3. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. CA Cancer J Clin 2012;62:147–72. Available at: https://onlinelibrary.wiley.com/doi/abs/10.3322/caac.21139. Retrieved August 24, 2018.

  4. 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 August 22, 2018.

 


 

 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 online 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 information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.

While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or ser
vices of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

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About ACOG
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG 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. www.acog.org 

About ASCCP 
ASCCP is a professional society for an interdisciplinary group of health care professionals including physicians, physician assistants, nurse practitioners, midwives and researchers, who are focused on improving lives through the prevention and treatment of anogenital and HPV-related diseases. For more information visit www.asccp.org.

About SGO
The Society of Gynecologic Oncology (SGO) is the premier medical specialty society for health care professionals trained in the comprehensive management of gynecologic cancers. As a 501(c)(6) organization, the SGO contributes to the advancement of women’s cancer care by encouraging research, providing education, raising standards of practice, advocating for patients and members and collaborating with other domestic and international organizations. www.sgo.org

 

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