ACS Calls for HPV Testing Alone for Cervical Cancer Screening

Human papillomavirus (HPV) testing every 5 years should be used to screen patients ages 25 to 65 for cervical cancer, according to updated guidelines released by the American Cancer Society (ACS).

The simplified guidelines state that women with a cervix should start molecular HPV testing at age 25 -- 4 years later than previous guidelines suggest. If primary HPV testing is not available, either a Pap test every 3 years or cotesting (i.e., combined cytology and HPV tests) every 5 years is acceptable, according to the new recommendations published in the ACS journal CA: A Cancer Journal for Clinicians.

Women with a cervix who are older than 65 should cease all screening, unless they have a history of cervical intraepithelial neoplasia (grade 2 or more severe disease) in the last 25 years, or do not have adequate previously documented negative testing.

"These streamlined recommendations can improve compliance and reduce potential harms," said Debbie Saslow, PhD, the ACS's managing director of HPV & GYN Cancers, in a statement.

Saslow added that compared with current guidelines that advise Pap testing alone at age 21 and switching to cotesting at age 30, starting primary HPV testing at age 25 will prevent 13% more cervical cancer cases and 7% more deaths. "Our model showed we could do that with a 9% increase in follow-up procedures, but with 45% fewer tests required overall," she said.

The ACS cited improvements in HPV vaccination rates among younger individuals -- which have been associated with a lower incidence of cervical cancer -- as a reason for increasing the recommended age to start screening to 25.

The recommendations are transitional -- i.e., while cotesting and cytology testing alone are acceptable, they should be phased out once barriers to primary HPV testing access are removed. Currently, the FDA has approved two primary HPV tests for cervical cancer screening.

Michael Randell, MD, an Atlanta-based ob/gyn in private practice, who was not involved in the development of the guidelines, told MedPage Today that he is shocked by the change, and called the suggestion to start screening at age 25 a possible "missed opportunity."

"I'm concerned that all this is based on epidemiology and statistics, and not based on practical application of cervical cancer screening programs in clinical practice," Randell said.

The American College of Obstetricians and Gynecologists (ACOG) said it will continue to adhere to its own guidelines, which state that beginning at age 21, women with a cervix should receive cytology testing alone every 3 years and transition to cotesting every 5 years at age 30.

In a statement to the press, Christopher M. Zahn, MD, ACOG's vice president of practice activities, said the organization looks forward to a more comprehensive review of the ACS recommendations to determine whether to update ACOG's clinical guidance.

"ACOG's current screening guidelines reflect a balance of benefit and potential harms and support shared decision-making between patients and their clinicians," Zahn said.

He added that the incidence of cervical cancer in the U.S. has been cut in half in the last 30 years because of widespread screening, and "an evidence-based approach to cervical cancer screening will allow us to continue to build on this progress."

The most recent guidelines by the U.S. Preventive Services Task Force recommend a Pap test alone every 3 years for women ages 21 to 65, or HPV testing alone or combined with Pap every 5 years starting at age 30.

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