New guidelines call for longer screening interval for cervical cancer

Guidelines on cervical cancer screening released separately this week by the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) agree on most recommendations, but contain a few differences.

Both sets of guidelines recommend that routine screening for average-risk women not be initiated until age 21. Women 21 to 29 years of age should be screened using cytology every three years, according to the guidelines. Both sets of guidelines also recommend against screening women over age 65 if they have had adequate prior negative screens. Screening is also not recommended in women who have had a hysterectomy and don't have a history of high-grade precancerous lesions or cervical cancer.

For women age 30 to 65, the guidelines from the ACS (which were co-sponsored by the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology) make a “preferred” recommendation of human papillomavirus (HPV) and cytology co-testing every five years. Screening with cytology alone every three years instead is “acceptable.” The USPSTF recommends choosing between cytology every three years or co-testing every five years based on whether a woman wants to lengthen the screening cycle. The ACS guidelines also add on a specific recommendation for HPV-vaccinated women: They should be screened at the same intervals as unvaccinated women of the same age.

Both guidelines were published online March 14, the USPSTF set in Annals of Internal Medicine and the ACS set in CA: A Cancer Journal for Clinicians. An editorial in Annals noted that clinicians and patients may be reluctant to follow these recommendations for less frequent screening. However, both sets of guidelines “clearly state that more frequent screening causes significant harm in terms of short-term psychological stress, vaginal bleeding and infection, and potential adverse pregnancy outcomes,” the editorialists wrote.

Because many women have used annual cervical cancer screening as an opportunity to address any other health issues and concerns, physicians and health care systems will have to develop new systems for making sure that such issues are still addressed, the editorialists added. The authors also urged promotion of HPV vaccination and expanding screening to reach the most vulnerable populations.