Are there any updates to cervical cancer screening guidelines?

From the Guidelines

Yes, there are updates to cervical cancer screening guidelines. The American Cancer Society (ACS) 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 (preferred) 1.

Key Updates

• The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available 1.
• The recommended age to start screening is 25 years rather than 21 years, with primary HPV testing preferred 1.
• Primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years 1.
• Individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, should discontinue all cervical cancer screening 1.

Rationale

The updates are based on the accumulation of evidence demonstrating the effectiveness of primary HPV testing and the high sensitivity for detecting precancers and predicting future risk 1.

• The disease burden of cervical cancer among individuals aged <25 years is very low, and the modeling study suggested that any incremental benefit conferred by starting screening at age 21 years with cytology and then switching to primary HPV testing at age 25 years would be very small compared with strategies starting at age 25 years with any screening test 1.
• Cytology-based screening is much less efficient in vaccinated populations, as abnormal cytology disproportionately identifies minor abnormalities resulting from HPV types that are associated with lower cancer risk 1.

Comparison with Other Guidelines

The USPSTF updated their cervical cancer screening recommendations in 2018, which differ from the ACS recommendations in the starting age for screening and the preferred screening strategy 1.

• The USPSTF recommends beginning screening at age 21 years with cytology alone, with transitions at age 30 years to using 1 of the 3 screening options described above 1.
• The ACS and USPSTF recommendations are consistent in not recommending screening for cervical cancer in individuals aged >65 years who have had adequate prior screening and are not otherwise under surveillance 1.

From the Research

Updates to Cervical Cancer Screening Guidelines

• The American Cancer Society (ACS) released updated cervical cancer screening guidelines in 2020, which endorse a shift in practice to primary human papillomavirus (HPV) screening in people with a cervix, beginning at ages of 25-65 years 2.
• The ACS suggests that cotesting or cytology may be excluded from future iterations of the guidelines when access to US Food and Drug Administration-approved primary HPV testing is not available 2.
• The American Society for Colposcopy and Cervical Pathology (ASCCP) endorses the 2018 US Preventive Services Task Force Recommendation Statement and supports the ACS cervical cancer screening guidelines 2.
• The ASCCP recommends any cervical cancer screening for secondary prevention of cervical cancer and suggests interventions that improve screening for those who are underscreened or unscreened 2.

Current Screening Strategies

• Currently available cervical cancer screening tests include hrHPV testing and cervical cytology screening 3.
• The screening strategies can be primary HPV screening, co-testing with HPV testing and cervical cytology, and cervical cytology alone 3.
• The new American Society for Colposcopy and Cervical Pathology guidelines recommend variable frequencies of screening and surveillance based on risk 3.

Implementation of Guidelines

• An ideal laboratory report should include the indication for the test (screening, surveillance, or diagnostic workup of symptomatic patients); type of test (primary HPV screening, co-testing, or cytology alone); clinical history of the patient; and prior as well as current testing results 3.
• The ASCCP recognizes the benefits and risks of primary HPV cervical cancer screening while acknowledging the barriers to widespread adoption, including implementation issues, the impact of limited HPV vaccination in the United States, and inclusion of populations who may not be well represented on primary HPV screening trials 2.