(Reaffirmed November 8, 2019)
The Society of Gynecologic Oncology and ASCCP endorse this document.
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.