American Cancer Society: Start cervical cancer screening at age 25 years, phase out Pap
An updated guideline issued by the American Cancer Society recommends cervical cancer screening with the HPV test every 5 years from age 25 years to 65 years.
“We now have stronger evidence to support starting cervical cancer screening at the later age of 25 years [rather than age 21 years] and to recommend screening with the HPV test as the preferred test, phasing out the Pap test and cotesting with the Pap test and HPV testing,” Debbie Saslow, PhD, managing director of cancer control interventions-HPV/GYN cancers at American Cancer Society, told Healio. “The update is based on decades of studies comparing the effectiveness of HPV testing with cytology, and bolstered by evidence of the impact of HPV vaccination, including a dramatic decline in cervical precancers and, more recently, cervical cancers among young women. Screening and management for the detection of cervical cancer and its precursors are based on a more robust understanding of the risk from persistent HPV infection.”
The society’s previous guideline, issued in 2012, recommended initiation of cervical cancer screening at age 21 years. Since then, HPV vaccination has led to decreased rates of precancerous cervical changes among women aged 20 to 24 years, data have shown. In addition, screening has not been shown to lower the rate of cervical cancer among women in this younger age group, whose HPV infections mostly become undetectable in 1 to 2 years, according to a press release.
The society estimated that the change to primary HPV testing starting at age 25 years would prevent 13% more cervical cancers and 7% more cervical cancer deaths than the previously recommended strategy.
The updated guideline also recommends that health care providers transition to primary HPV testing only, based upon data that suggest higher accuracy with the HPV test, which can be administered less often than the Pap test. However, HPV/Pap cotesting every 5 years or Pap testing alone every 3 years are acceptable options, because some laboratories have not yet transitioned to primary HPV testing.
“The recommendations do not take away access for anyone,” Saslow told Healio. “We deliberately retained suboptimal screening strategies (cotesting and the Pap test alone) as acceptable options so that no one would have a problem accessing cervical screening. The American Cancer Society will be working with our partners and the health community from now until the next guideline update to ensure a transition to primary HPV testing with the goal of complete access so that we can discontinue cotesting and cytology.”
Saslow said primary HPV testing has been supported by a tremendous amount of data, and other countries around the world have already made the transition.
“[Although] the driving force of American Cancer Society guidelines is the scientific evidence, we hope that such streamlined guidance will improve screening rates, which despite decades of use, are still not optimal,” Saslow said. “Screening women who have not previously been screened or have not been screened regularly will prevent more cervical cancers.”
For more information:
Debbie Saslow, PhD, can be reached at American Cancer Society, 250 Williams St., Suite 600, Atlanta, GA 30303; email: firstname.lastname@example.org.