The American Cancer Society (ACS) published new recommendations for cervical cancer screening that focus on HPV test and approves the use of self-collected samples. The recommendations, which apply to anyone with an average-risk cervix, also specify the age at which screening should start and stop.
The ACS is one of two groups that make recommendations about screening for different types of cancer. The other group is United States Preventive Service Task Force (USPSTF) made up of independent doctors, nurses and public health specialists. Their recommendations affect what health insurance will pay. The USPSTS is also in the process of revising its cervical cancer screening guidelines.
Here’s what everyone should know about the new ACS screening recommendations:
- Primary HPV: The ACS recommends that providers use a primary HPV test that looks for the presence of the types of HPV (human papillomavirus) known to cause nearly all cases of cervical cancer. If the primary HPV test is not available, the ACS recommends co-testing. Concurrent testing includes an HPV test done at the same time as a Pap test (also called cytology). If that’s not available, the ACS says providers can use the Pap test themselves.
- Screening starts on the 25th: The ACS recommends that people start screening at age 25, regardless of the test they get. This is partly because cervical cancer is rare in younger people. This is different from the USPSTF’s current recommendations that suggest people get Pap smears between the ages of 21 and 29 and then start initial HPV screening or co-testing at age 30.
- Self-collection is acceptable: Traditionally, all samples for HPV testing or Pap smears were collected by a healthcare provider during a Pap test. ACS continues to say that this is the preferred collection method, but acknowledges that this may be difficult for some people or in some areas. In these cases, the ACS says self-collected HPV tests are an acceptable alternative.
- Three to five year follow-up: The recommendations explain that how often a person should be tested depends on what tests they had and how the samples were collected. People who have an initial HPV test or co-test using a provider-collected sample and have normal results should be retested in five years. People who collect their own HPV test samples and have normal results should be retested in three years. People who only have a Pap test and have normal results should be screened again in three years. Anyone with abnormal results will likely need to be tested more often.
- It ends at 65 if the test results were normal: The ACS recommends that people stop screening at age 65 if they’ve had a decade of normal results. This means either they had a negative HPV test at 60 and 65, or they had three consecutive negative Pap tests, the last of which was at age 65.
There are nearly 14,000 cases of cervical cancer diagnosed in the United States each year, and more than 4,000 women die from the disease annually. The good news is that cervical cancer develops very slowly and can be detected and treated before it becomes cancerous. That’s why screening is so important.
In the US, widespread screening for cervical cancer has reduced the number of cancer cases by more than half since the mid-1970s. Today, more than half of cervical cancer diagnosed in this country occurs in people who have never been screened or who are rarely screened.
These new guidelines offer several options for screening, including self-collection, which will hopefully make it easier for more people to be screened. People can potentially be tested at their primary care provider’s office, an urgent care clinic, a mobile clinic, or even some pharmacies. Or they can choose to collect their sample at home. This could be especially helpful for people who do not have access to a gynecologist or who are uncomfortable with vaginal exams.
“These updated recommendations will help improve screening compliance and reduce the risk of cervical cancer,” explained Dr. Robert Smith, senior vice president, early cancer science at the American Cancer Society. Dr Smith went on to say that the development of self-collection tools would “broaden access to screening”.
