March 14, 2012 -- Combining a Pap test with a human papillomavirus (HPV) test can safely extend the interval between cervical cancer screenings from three years to five years in many women between the ages of 30-65, according to new recommendations.
If women opt for the Pap test alone, the new guidelines are similar to the old ones, recommending screening every three years.
A key addition to the new guidelines is the recommendation concerning HPV testing. Previously, researchers from the U.S. Preventive Services Task Force (USPSTF) said they didn’t have enough evidence to specifically recommend for or against the test. Now, if HPV tests and Pap tests are negative, women aged 30-65 can extend the cervical cancer screening interval to five years.
“People need to get screened, but they don’t need to do it too often,” says Virginia Moyer, MD, MPH, a professor of pediatrics at Baylor Medical College and chair of the U.S. Preventive Services Task Force, which published an updated version of its 2003 recommendations online in the Annals of Internal Medicine.
The American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology also released new sets of guidelines that are nearly identical to those from the USPSTF.
The harms of more frequent screening -- such as a greater chance of abnormal test results that can lead to further, sometimes invasive testing -- outweigh the benefits of early detection of slow-growing precancerous changes in the cervix, the authors of the guidelines conclude. Often, those precancerous changes resolve without any treatment. Persistent infection with certain types of HPV can lead to cervical cancer.
Women should begin screening at age 21, according to the recommendations. Previous USPSTF guidelines recommended that women begin screening within three years of becoming sexually active or at age 21, whichever came first. In its new update, though, the task force says it found little evidence that sexual history should affect the age at which women begin to get screened. And, the guidelines note, there is no evidence that screening women younger than 21 reduces diagnoses of or deaths from cervical cancer.
HPV testing is not recommended for women in their 20s because people in that age group can have HPV infections that resolve without treatment.
Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But women who have a history of a more advanced precancer diagnosis should continue to be screened for at least 20 years.
And women of any age who’ve had a hysterectomy with removal of the cervix and no history of cervical cancer or advanced precancerous abnormalities do not need to be screened, according to the guidelines.