by Terri Schmitt, PhD, APRN, FNP-BC, FAANP

January is cervical cancer awareness month and in the past year, amidst all the pandemic information and updates, cervical cancer screening guidelines established by the USPSTF were endorsed by both ACOG and the ASCP.  After just over 15 years of FDA approval of HPV vaccines and data trending, this effective screening method remains the tool of choice for early detection. As with prior guidelines screening is not recommended prior to age 21 or after age 65. Below is a summary of the guidelines.

Screening

• Anyone with a cervix age 21 to 65 should be screened.
• Ages 21 to 29 – cytology screening alone every three years.
• Ages 30 to 65 can be screened by any one of the following methods:
  • Only cytology every three years
  • Primary High Risk Human Papillomavirus (hrHPV) testing alone every 5 years, if an FDA approved test
  • Using both cytology and hrHPV testing together every 5 years
• Older than age 65 – no screening if ‘negative prior screening’.
• For those with hysterectomy and cervix removal, no screening needed if no history of previous high grade pre-cancerous findings or cervical lesions.
• Guidelines are the same for anyone with a cervix regardless of HPV vaccination history and who do not have any symptoms of cervical cancer.
• Adequate ‘negative prior screening’ is defined as three negative cytology results, 2 negative co-testing cytology and hrHPV testing, or 2 negative hrHPB testing results within the 10 years prior.¹

Of note is that in 2020 the American Cancer Society recommended primary hrHPV testing as their preferred screening option for patients age 25 to 65, but access to FDA approved tests, strains on infrastructure of production and labs and access to this type of testing in rural and under-served areas has proved challenging, leaving some at a continued disadvantage to optimal screening.² The efficacy of hrHPV testing is promising, with a 2 to 2.7 fold higher detection ability for grade 2 and higher cervical intraepithelial neoplasia.³

Adherence to the above screening schedule and type of screening is recommended for all patients and will serve to improve patient outcomes and early detection. For more on cervical cancer screening guidelines visit the USPSTF at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening.

 

References

1. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. JAMA 2018;320:674-86. Available at: https://jamanetwork.com/journals/jama/fullarticle/2697704. Retrieved Jan 10, 2022.
2. American College of Obstetrics and Gynecology. Practice Advisory: Updated cervical cancer screening guidelines. April, 2021. Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines. Retrieved Jan 10, 2022
3. Zhang J, Zhao Y, Dai Y, et al. Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China: A Multicenter, Open-label, Randomized Clinical Trial. JAMA Oncol.2021;7(2):263–270. doi:10.1001/jamaoncol.2020.6575. Available at: https://jamanetwork.com/journals/jamaoncology/fullarticle/2774442. Retrieved Jan 10, 2022