Guidance Update: Professional Organizations Align on Cervical Cancer Screening
ACOG has joined ASCCP and the SGO in endorsing the USPSTF cervical cancer screening recommendations. The ACOG practice document states that
Consistent with prior guidance, screening should begin at age 21 years, and screening recommendations remain unchanged for average-risk individuals aged 21–29 years and those who are older than 65 years
Management of abnormal cervical cancer screening results should follow current ASCCP guidelines
The USPSTF recommends the following (Grade A – “Offer or Provide this Service”)
Begin screening at age 21
Screen every 3 years with cytology alone
Do not perform HPV testing routinely
Age 30 to 65 can be screened
Every 5 years ‘cotesting’ with cytology plus HPV
Every 3 years with cytology only
every 5 years with high-risk human papillomavirus (hrHPV) testing alone
The USPSTF recommends against the following (Grade D – Discourage the use of this service)
Do not offer screening
Do not offer screening in the setting of adequate prior screening and otherwise not at high risk for cervical cancer
Do not offer screening following hysterectomy if
Cervix was removed and
There is no history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer
Cervical cancer rates in the United States are low due largely to access to effective screening. Cervical cancer is believed with a high degree of certainty, to be the delayed consequence of infection with high risk or oncogenic human papillomavirus (HPV). The majority of HPV infections are transient and do not progress to cervical cancer. However, the consequences of missing precancerous or early cancerous lesions are potentially lethal and should be avoidable with appropriate screening.
The goal of cervical cancer screening is to minimize harm and maximize benefit
Guidelines focus on increasing the age at which to begin screening, lengthening the screening interval and discontinuing screening women at low risk for future cervical cancer
The above action items refer to average risk women
Women at increased risk for cervical cancer require a higher level of surveillance and include those who are
Immunocompromised (HIV positive, organ transplant recipient, chronic steroid use)
Women with multiple partners or high risk partners
Women with a history of abnormal Pap smear or precancerous genital conditions
Women with a history of sexually transmitted diseases
ACOG has responded to the American Cancer Society (2020) recommendation that hrHPV testing in isolation every 5 years should be prioritized for women 25 to 65 years of age
hrHPV alone has demonstrated efficacy and efficiency
However, the ACOG Practice Advisory notes significant limitations regarding current healthcare infrastructure, including
Limited access to primary hrHPV testing is of particular concern in rural and under-resourced communities and among communities of color, which have disproportionately high rates of cervical cancer incidence, morbidity, and mortality
Although HPV self-sampling has the potential to greatly improve access to cervical cancer screening, and there is an increasing body of evidence to support its efficacy and utility, it is still investigational in the United States
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