The US Preventive Services Task Force (USPSTF) updated its screening recommendations for cervical cancer, according to a statement published in JAMA. This marks the first USPSTF recommendation update since 2012.
Although the total number of deaths attributed to cervical cancer have decreased in the past 2 decades to 2.3 deaths per 100,000 women from 2.8 per 100,000, an estimated 13,240 new cases and 4170 deaths will occur in 2018. Evidence suggests that most cases of cervical cancer occur among women who have not been appropriately screened; improved recommendations and strategies may continue to reduce mortality associated with cervical cancer.
For this update, the USPSTF reviewed evidence from trials and cohort studies in high-resource countries assessing the effectiveness of high-risk human papillomavirus (hrHPV) testing or hrHPV testing plus cytology testing compared with cytology testing alone. The USPSTF made the following Grade A recommendations (recommended service with high certainty of net benefit):
For women aged 21 to 29, screenings for cervical cancer performed every 3 years with cytology alone outweighs the harms.
For women aged 30 to 65, screenings for cervical cancer performed every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with co-testing outweighs the harms.
They also added that screening women 65 years and older who had undergone previous adequate screening, women younger than 21 years, and women who have undergone a hysterectomy with cervix removal for indications other than high-grade precancerous lesions or cervical cancer, does not confer any significant benefit (Grade D recommendation).
The major change in the updated vs the 2012 recommendations is that hrHPV testing alone is now recommended as an alternative to screening every 3 years with cytology alone among women aged 30 to 65 years.
Curry SJ; US Preventive Services Task Force. USPSTF Recommendation Statement on Screening for Cervical Cancer [published online August 21, 2018]. JAMA. doi: 10.1001/jama.2018.10897