Does a family history of cervical cancer impact screening recommendations?

From the Guidelines

Family history of cervical cancer does not significantly alter the standard cervical cancer screening recommendations for most women, and they should follow the guidelines for the general population, which includes primary human papillomavirus (HPV) testing every 5 years starting at age 25, or cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years 1. The American Cancer Society recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years, and this recommendation does not change based on family history alone 1. However, if there is a known genetic syndrome in the family that increases cancer risk or multiple family members with cervical cancer, more frequent screening might be considered on an individual basis, but this is not supported by the most recent guidelines 1. The reason family history doesn't typically alter screening is because most cervical cancers are caused by persistent HPV infection rather than inherited genetic factors, and HPV vaccination is strongly recommended for eligible individuals regardless of family history, ideally before becoming sexually active, as it can prevent the infections that lead to most cervical cancers. Some key points to consider when evaluating the need for screening include:

• Age to start screening: 25 years
• Screening interval: every 5 years for primary HPV testing, or every 5 years for cotesting, or every 3 years for cytology alone
• Screening cessation: after age 65 with adequate prior screening and no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years
• Importance of HPV vaccination: strongly recommended for eligible individuals regardless of family history. Women should discuss their specific family history with their healthcare provider to determine if any personalized adjustments to screening are warranted based on their individual risk factors, but the current guidelines do not support changing the screening recommendations based on family history alone 1.

From the Research

Screening Recommendations

• The American Academy of Family Physicians and the U.S. Preventive Services Task Force recommend starting screening in immunocompetent, asymptomatic women at 21 years of age 2.
• Women 21 to 29 years of age should be screened every three years with cytology alone, while women 30 to 65 years of age should be screened every five years with cytology plus HPV testing or every three years with cytology alone 2.
• Screening is not recommended for women younger than 21 years or in women older than 65 years with an adequate history of negative screening results 2.

Family History and Screening

• A study found that self-reported family history of cancer was not predictive of recent Pap test behavior, with an odds ratio of 1.17 and a 95% confidence interval of 0.55-2.51 3.
• The study suggests that targeting older women with screening recommendations and providing available screening resources for underserved women may be more effective than considering family history 3.
• There is no direct evidence to suggest that a family history of cervical cancer changes screening recommendations 2, 3, 4, 5, 6.

Screening Methods

• Screening methods include cytology (Papanicolaou test) and HPV testing, alone or in combination 2, 4, 6.
• Primary screening with HPV DNA testing followed by cytological triage and repeat HPV DNA testing of HPV DNA-positive women with normal cytology may be an effective strategy 4.
• HPV testing with individual HPV-16/HPV-18 genotyping could represent a more accurate methodology for primary cervical cancer screening in comparison to liquid-based cytology, especially in older women 6.