HPV test alone OK for cervical cancer screening over 30: expert panel
The independent U.S. Preventive Services Task Force (USPSTF)—which issues closely heeded guidelines on a range of medical issues—says the test for the human papillomavirus (HPV) can be used once every five years for women aged 30 to 65, in lieu of the once every three-year Pap test.
Prior guidelines had called for the use of both tests together.
For younger women, aged 21 to 29, a Pap test once every three years is still the recommended screen, the panel said.
Certain strains of sexually transmitted HPV are thought to cause the vast majority of cervical cancer cases.
"One of the biggest differences between these guidelines and the former guidelines is that the new guidelines recommend against co-testing—HPV test and a Pap test at the same time—for women at the ages of 30 to 65," noted Dr. Stephanie Blank, an ob/gyn who reviewed the guidelines.
Instead, "the new guidelines are recommending Pap alone with [follow-up lab tests] every three years or HPV testing alone every five years, but not both together," said Blank. She directs Women's Health at Mount Sinai Downtown Chelsea Center in New York City.
As she explained, the rationale behind the change was that—based on the evidence—there was no increase in deaths whether women got both tests together or just the one test.
According to the new USPSTF advisory, cervical cancer screening is not recommended for women who are younger than 21, older than 65 (who have already had regular screenings when they were younger), and women of any age who do not have a cervix because they've undergone a hysterectomy.
The draft recommendation is a change from the panel's 2012 recommendation, which said that women aged 30 to 65 receive both the Pap test and HPV test at the same time.
The task force is an independent, volunteer panel of experts in prevention and evidence-based medicine. The draft recommendation is open for public comment on the task force's website between Sept. 12 and Oct. 9.
"Cervical cancer is highly curable when found and treated early," task force member Dr. Carol Mangione said in a panel news release.
"Most cases of cervical cancer occur in women who have not been regularly screened or treated," explained Mangione, who heads the division of general internal medicine and health services research at the University of California, Los Angeles' School of Medicine. "Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer."
Dr. Eva Chalas is chief of gynecological oncology at NYU Winthrop Hospital Cancer Center in Mineola, N.Y. Reviewing the new guidelines, she noted that "some European countries are using HPV as primary screening and only performing [the Pap test] as a secondary analysis."
Chalas added that "many physicians believe that this [newer] method provides greater accuracy for detection of both pre-cancerous and cancerous lesions. The Society of Gynecologic Oncology has supported HPV testing as described above for several years."
For her part, Blank said the focus on preventing or spotting HPV infection is crucial in the fight against cervical cancer.
"Getting your HPV vaccine [when young] is very important because this is a completely preventable disease," she said. And she believes every woman should have a discussion with her doctor as to which type and frequency of testing is best for her.
"Guidelines are not appropriate for every patient," Blank said. "Guidelines should be followed, but you also need some physician judgment in there as well."
The U.S. National Cancer Institute has more on cervical cancer.
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