ACOG: New Recommendations for Cervical Cancer Screening
Recommendations provide guidance on frequency of screening, appropriate screening methods
In a practice bulletin published in the January issue of Obstetrics & Gynecology, new recommendations are presented for cervical cancer screening and prevention.
WEDNESDAY, Dec. 23, 2015 (HealthDay News) — In a practice bulletin published in the January issue of Obstetrics & Gynecology, new recommendations are presented for cervical cancer screening and prevention.
The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening. In 1975, the rate was 14.8 per 100,000 women. By 2011, it decreased to 6.7 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.3 per 100,000 women in 2011 (1). The American Cancer Society (ACS) estimated that there would be 12,900 new cases of cervical cancer in the United States in 2015, with 4,100 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 527,624 new cases of the disease and 265,672 resultant deaths each year (3). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (4, 5).
New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results. In addition, there are different risk–benefit considerations for women at different ages, as reflected in age-specific screening recommendations. In 2011, the ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) updated their joint guidelines for cervical cancer screening (6), as did the U.S. Preventive Services Task Force (USPSTF) (7). Subsequently, in 2015, ASCCP and the Society of Gynecologic Oncology (SGO) issued interim guidance for the use of a human papillomavirus (HPV) test for primary screening for cervical cancer that was approved in 2014 by the U.S. Food and Drug Administration (FDA) (8). The purpose of this document is to provide a review of the best available evidence regarding the prevention and early detection of cervical cancer.
Members of the American College of Obstetrics & Gynecology’s Committee on Practice Bulletins reviewed the best available evidence regarding the prevention and early detection of cervical cancer.
Based on good and consistent scientific evidence (level A), the authors recommend that cervical cancer screening should begin at age 21 years; younger women should not be screened, with the exception of women who are infected with HIV. Cervical cytology alone should be used for women aged 21 to 29 years, and screening should be performed every three years. Women younger than 30 years should not undergo co-testing. Cytology and human papillomavirus (HPV) co-testing every five years is preferred for women aged 30 to 65 years; cytology alone every three years is acceptable. Acceptable screening methods include liquid-based and conventional methods of cervical cytology collection. Screening should be discontinued after age 65 years in women with adequate negative prior screening test results. Routine cytology and HPV testing should be discontinued and not restarted for women who have had a total hysterectomy and never had cervical intraepithelial neoplasia 2 or higher. More frequent screening is appropriate for certain women, including those infected with HIV.
“Cervical cancer screening recommendations are always evolving just like the technology behind the screening tests,” David Chelmow, M.D., who led in the development of the bulletin, said in a statement.