USPSTF updates recommendations for cervical cancer screening

The United States Preventive Services Task Force (USPSTF) Updated draft statement About cervical cancer screening. The statement is made available to: public comment It will be published on the task force's website until January 13, 2025.

The task force stressed that nearly all cases of cervical cancer are caused by the human papillomavirus (HPV), and most occur in women who do not receive regular testing or appropriate treatment.

New screening options

In 2024, the number of new cases of cervical cancer is estimated to be 13,820. 4360 people died.

“The evidence is that testing saves lives, and all women between the ages of 21 and 65 should be tested,” said task force member Esa Davis, MD, MPH, FAAFP, Chair of Family and Community Medicine. Professor and vice president of community health at the center said. Interview from the University of Maryland, Baltimore. New features in the 2024 draft statement supporting self-collection of cervical samples for HPV testing could encourage more widespread screening.

“We hope that this new and effective self-collection option will expand testing and allow more women to get tested regularly,” Davis said. “Some people may feel more comfortable collecting the sample themselves. Collection can be office-based or home-based, but it is very important that it is done under the direction of a clinician.”

Dr. Diego Aviles, assistant professor and gynecologic oncologist at UT Health Houston, agrees. “A voluntary recall will absolutely expand the review process. I think it's an amazing advance in medicine that patients don't have to come into the office for an uncomfortable pelvic exam and can have it done in the comfort of their own home. ” he said in an interview. “This empowers patients and gives them choice.”

As for concerns about potential errors, he added that while this is a theoretical concern, “many studies show that self-collection is just as effective as collection by a doctor.”

Closely consistent with the task force's 2018 screening Recommendationsthe updated proposal also aligns with proposals from other organizations, including: American College of Obstetricians and Gynecologists (ACOG)said Davis.

Christopher M. Zahn, M.D., ACOG's director of clinical practice and health equity and quality, emphasized the importance of cervical cancer screening and said his organization will review the USPSTF's recommendations. He urges ACOG members to consider them and provide comments on the public input platform.

Based on the latest evidence, the task force also found that HPV screening alone provides an optimal balance of benefits and harms for women aged 30 to 65 years with respect to the detection and prevention of cervical cancer, while at the same time It also emphasized for the first time that it will continue to be strengthened. Pap tests and concurrent testing are also considered effective screening options for these women.

The current draft statement applies to cisgender women and people assigned the female gender at birth, including transgender men and non-binary individuals. This recommendation does not apply to women who are at increased risk for cervical cancer, such as HIV infection, a weakened immune system, or a history of precancerous lesions or treatment for cervical cancer.

Based on a review of the evidence regarding the benefits and harms of testing, an independent panel of USPSTF national experts recommended the following:

Recommendations for Screening (based on grade A evidence):

• From 21 to 65 years old: All women should be tested regularly for this preventable disease.
• 21-29 years old: all women People in this age group should have a Pap test every three years, but an HPV test is not required. “In this age group, younger women have stronger immune systems and most HPV infections clear up on their own. Older women are more likely to have long-lasting HPV infections and should be tested for the virus,” Davis said. said.
• From 30 to 65 years old: As pointed out, HPV screening provides an optimal balance of benefits and harms in terms of preventing and detecting cervical cancer for women in this age group. Pap testing or co-testing (Pap and HPV testing) is also an effective screening option for this population. Ideally, these women should have an HPV test every 5 years, a Pap test every 3 years, or a combined HPV and Pap test (co-testing) every 5 years. There is.

Recommendations against Screening (no benefit or benefit outweighs harm – grade D evidence):

• woman Under 21 years old: No screening required.
• Other women who do not require screening: Screening is also not necessary for people of any age who have had a hysterectomy, which involves removing the cervix, or for people over 65 who have had regular screenings with normal results. This means normal results from the last 3 cervical cancer tests or the last 2 HPV tests completed in the past 10 years and at least one test taken in the past 5 years .
• Women over 65 years old: These women may have not been screened regularly or have had an abnormal result in the past 10 years, such as a high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer. Screening should only continue if.

Davis noted that none of the current recommendations are likely to be controversial or cause a backlash. “But,” Aviles says. With any recent change in medicine, there is always some backlash, and it may take some time for everyone to get used to the option of self-collection. This recommendation still gives doctors leeway to use whatever screening tests they feel comfortable with, but I think everyone will eventually turn to self-sampling. ”

Looking to the future, he added, “In the next few years we will need to look at women who are taking immune-compromising drugs like Skyridi.” [risankizumab] For skin diseases such as psoriasis. These are often used by young people and can increase the risk of cervical cancer. I haven't seen much conversation about this, but patients need to be aware of this risk and recommendations for this group should be different than for the general population. ”

The USPSTF also noted the need to evaluate the incremental benefits and harms of screening and multiple intervals of primary HPV screening in HPV vaccination cohorts of the US population.

Davis, Aviles and Zahn had no relevant competing interests to disclose.

Diana Swift is an independent medical journalist based in Toronto.