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CMECNE

Cervical Cancer Screening Guidelines – Including ‘HPV Only’ Option

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Relate the significant change in the USPSTF cervical screening guidelines
2. Recall the new USPSTF cervical screening guidelines

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

SUMMARY:

The USPSTF, based on latest evidence, has released final guidelines for cervical cancer screening (August 2018). The final recommendations now include ‘HPV only’ as an option for women 30 to 65 years of age.

USPSTF recommends the following

Women ages 21 to 65 years – Recommendation Grade A (offer or provide this service)

21 to 29 years

  • The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone

30 to 65 years

  • The USPSTF recommends screening
    • Every 3 years with cervical cytology alone or
    • Every 5 years with high-risk human papillomavirus (hrHPV) testing alone or
    • Every 5 years with hrHPV testing in combination with cytology (cotesting)

Women older than age 65 years – Recommendation Grade D (discourage the use of this service)

  • The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer

Women younger than age 21 years – Recommendation Grade D (discourage the use of this service)

  • The USPSTF recommends against screening for cervical cancer in women younger than age 21 years

Women who have had a hysterectomy – Recommendation Grade D (discourage the use of this service)

  • The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer

KEY POINTS:

  • The first three recommendations (not the recommendation related to hysterectomy) apply to women who have a cervix, regardless of their sexual history or HPV vaccination status
  • None of these recommendations apply to women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer
  • These recommendations also do not apply to women with in utero exposure to diethylstilbestrol or women who have a compromised immune system (e.g., women living with HIV)

ACOG Practice Advisory Update (August 2018)

  • The ACOG Practice Advisory Update (endorsed by SGO and ASCCP) states

ACOG affirms its current cervical cancer screening guidelines, 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.

  • The ACOG Practice Advisory Update refers to the Interim Clinical Guidance for primary hrHPV testing, based on expert panel (Obstetrics & Gynecology, 2015) evidence review
  • Panel Representation included
    • SGO | ASCCP | ACOG |ACS | American Society of Cytopathology | College of American Pathologists | American Society for Clinical Pathology
  • The ACOG Practice Advisory Update summarizes the expert opinion as follows
    • Preferred: Co-testing (cervical cytology and hrHPV testing) every 5 years
    • Acceptable: Screening with cervical cytology alone every 3 years
    • Can be considered: HrHPV testing alone as an alternative screening strategy (re-screen not more frequently than every 3 years)

American Cancer Society (2020)

  • 25 to 65 years of age
    • ‘Primary’ HPV testing every 5 years 
  • If HPV testing is not available, other acceptable screening methods 
    • HPV and cervical cytology every 5 years or
    • Cervical cytology along every 3 years
  • Women >65: Stop screening if patient meets the following criteria
    • Regular screening in the past 10 years with normal results and no history of CIN2 or higher in the past 25 years
  • Total hysterectomy
    • Stop screening (unless surgery was for cervical cancer or pre-cancer)
  • Supra-cervical hysterectomy
    • Continue screening
  • Patients who have had HPV vaccine
    • Continue to screen based on guidelines

Learn More – Primary Sources:

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement

ACOG Practice Advisory: Cervical Cancer Screening (Update)

Use of Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening: Interim Clinical Guidance (Obstetrics & Gynecology, 2015) 

The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer

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Related ObG Topics:

Practical info for your gynecology practice
Screening for Cervical Cancer in the Woman at Average Risk
Cervical Cytology and HPV Screening in the HIV Positive Woman
HPV Vaccine Recommendations Including Guidance for Ages 27 to 45

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OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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