Gynecology

USPSTF: Use HPV Testing to Screen for Cervical Cancer

Primary high-risk human papillomavirus (hrHPV) testing should be an option for cervical cancer screening among women aged 30 to 65 years, according to new guidelines from the USPSTF.

 

In order to update their 2012 recommendations on screening for cervical cancer, the USPSTF conducted a review of available evidence, including clinical trials and cohort studies evaluating screening with hrHPV testing along or in combination with cytology (cotesting). A decision analysis model was also commissioned to evaluate the age at which screening should begin and end, optimal intervals for screening, benefits and harms of screening strategies, and the effectiveness of screening strategies.

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Overall, they found that screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years was associated with substantial reductions in cervical cancer incidence and morality. Harms and risks were moderate in women aged 30 to 65 years.

 

Based upon these results, the USPSTF recommended:

  • Screening every 3 years with cervical cytology alone in women aged 21 to 29 years
  • Screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing and cytology (cotesting) (A recommendation)
  • Do not screen women older than 65 years who have had adequate screening and are not at high risk (D recommendation)
  • Do not screen women younger than 21 years (D recommendation)
  • Do not screen women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion (D recommendation)

 

“The major change in the current recommendation is that the USPSTF now recommends screening every 5 years with hrHPV testing alone as an alternative to screening every 3 years with cytology alone among women aged 30 to 65 years. These are the 2 preferred screening strategies based on the USPSTF review of trial, cohort, and modeling results.”

 

—Michael Potts

 

Reference:

USPSTF. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674-686.