American Cancer Society updates guidelines on cervical cancer screening

For more than a half century, cervical cytologic testing, first with the Papanicolaou (Pap) test and more recently with liquid‐based cytology, has been the foundation for screening for cervical cancer and has been highly effective in substantially reducing the burden of this disease in the United States as well as globally

The new guidelines recommends that average-risk individuals should begin cervical cancer screening at age 25 — rather than at age 21, as recommended in 2012. The guideline update has been published in CA: A Cancer Journal for Clinicians.

These streamlined recommendations can improve compliance and reduce potential harms," said Debbie Saslow PhD, managing director, HPV & GYN Cancers for the American Cancer Society. "They are made possible by some important developments that have allowed us to transform our approach to cervical cancer screening, primarily a deeper understanding of the role of HPV and the development of tools to address it."

Major recommendations-

1.Individuals with may initiate cervical cancer screening at age 25 and undergo primary HPV testing every 5 years through age 65 . In case the primary HPV testing is not available, individuals aged 25-65 years should be screened with HPV testing in combination with cytology every 5 years or cytology alone every 3 years.

2.HPV testing in combination with cytology or cytology testing alone are included as acceptable options for cervical cancer screening because access to an HPV test that has been approved by the FDA for primary screening may be limited in some settings.

3.Individuals who are older than age 65 years and who have no history of CIN2+ within the past 25 years, with documented adequate negative prior screening in the 10-year period prior to age 65 may discontinue cervical cancer screening with any modality.

4.Adequate negative prior screening is currently defined as 2 consecutive, negative primary HPV tests or 2 negative cotests or 3 negative cytology tests within the past 10 years, with the most recent test occurring within the past 5 years. These criteria do not apply to persons who are currently under surveillance for abnormal screening results.

5.Cervical cancer screening may be discontinued in individuals of any age with limited life expectancy.

6.In case sufficient documentation of prior screening meeting criteria for screening cessation is not available, individuals with a cervix who are older than age 65 years, without conditions limiting life expectancy, should be screened until criteria are met.

7.Follow‐up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration‐approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow‐up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

There are currently two approved primary HPV tests, and access to them may be limited. The ACS says that cotesting or cytology alone "should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers."

The guidance is applicable to all average-risk, asymptomatic people with a cervix, including transgender men who still have a cervix. All these individuals should be screened regardless of their HPV vaccination status or sexual history.