Cervical Cancer Screening Guidelines Updated

Early this summer, the U.S. Preventive Services Task Force (USPSTF) issued an update of the 2003 recommendation statement on screening for cervical cancer. The update was published in Annals of Internal Medicine [2012;156(12):880-891].

The USPSTF bases its recommendations on evidence of benefits and harms of a service as well as an assessment of the balance between the 2; costs of providing the service are not part of the considerations made.

The recommendations for cervical cancer screening apply to women who have a cervix, regardless of sexual history. They do not apply to women with a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised.

Women 21 to 65 years of age are advised to undergo screening for cervical cancer with cytology (Papanicolaou [Pap] smear) every 3 years. For women 30 to 65 years of age who want to lengthen the interval between screenings, the USPSTF recommends screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

Screening for women <21 years of age is not recommended. Likewise, screening for women >65 years of age is not recommended if they have had adequate prior screening and are not at high risk for cervical cancer. The USPSTF also recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion or cervical cancer.

In the Rationale section of the Guideline, the authors noted that the age-adjusted annual incidence rate of cervical cancer is 6.6 cases per 100,000 women. In 2012, there were an estimated 12,200 new cases of cervical cancer and 4210 deaths in the United States. Since the implementation of widespread screening for cervical cancer, deaths related to cervical cancer have decreased dramatically and “strategies that aim to ensure that all women are screened at the appropriate interval and receive adequate follow-up are most likely to be successful in further reducing cervical cancer incidence and mortality in the United States,” the report states.

In women 21 to 65 years of age, there is substantial evidence that screening women with cytology every 3 years reduces cervical cancer incidence and mortality. In women <21 years of age, evidence exists that compared with initiating screening at 21 years of age, screening in women <21 years of age does not reduce the incidence of, or mortality associated with, cervical cancer. In women >65 years of age who have had adequate prior screening and are not at high risk, there is substantial evidence that there is little to no benefit in screening for cervical cancer.

The benefits of screening every 3 years with cytology outweigh the potential harms for women 21 to 65 years of age. For women <21 years of age and >65 years of age who have had adequate prior screening, the task force concludes that there is moderate certainty that the benefits of screening do not outweigh the possible harms.