Screening with cervical cytology alone, primary high-risk human papillomavirus (HPV) testing alone, and cotesting are all options for detecting high-grade precancerous cervical lesions and cervical cancer, the U.S. Preventive Services Task Force recommended.
The grade A recommendation for women ages 30 to 65 years now includes primary HPV testing (without cotesting) every five years as an option, along with the previous recommendation of HPV and cytology cotesting every five years or continuation of cervical cytology every three years. The Task Force also recommends screening with cervical cytology alone every three years in women ages 21 to 29 years (Grade A recommendation).
For women older than 65 years who have had adequate prior screening and women younger than 21 years, screening does not provide significant benefit, the Task Force said (grade D recommendations). Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. Both of these recommendations carried moderate to high certainty, the Task Force said.
According to an accompanying editorial, the recommendation statement preserves the greatest range of choices for practitioners and patients, but how the new guidelines will affect patient and clinician adherence, screening program participation, and ultimately cervical cancer mortality remains to be determined.
“Clinicians have all the tools necessary to make cervical cancer mortality a memory. When delivered as recommended to children, prophylactic HPV vaccination is highly effective in preventing [high-risk] HPV infection associated with cervical cancer,” the editorial concluded
A second editorial in JAMA Internal Medicine stated that the Task Force estimates that high-risk HPV testing alone and cotesting would avert one additional cancer case per 1,000 women screened compared with cytology alone, representing a “very small” improvement in life-years gained.
“Value can be considered from various perspectives,” the editorial concluded. “From the perspective of individual women, the USPSTF states that those aged 30 to 65 years ‘should discuss with their health care professional which testing strategy is best for them.’”