The changing epidemiology of HPV and cervical cancer



New Guidelines Further Simplify Cervical Cancer Screening

Some women may undergo a single test once every five years.

By Shari Roan

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Cervical cancer is the fourth most common cancer in women, but it is typically treatable if caught early on.
Cervical cancer is the fourth most common cancer in women, but it is typically treatable if caught early on.
Iryna Inshyna/Shutterstock

August 21, 2019

Many women can now undergo cervical cancer screening once every five years with a single test, according to new guidelines released today from the U.S. Preventive Services Task Force (USPSTF).

The updated cervical cancer screening guidelines, published in theJournal of the American Medical Association (JAMA), are similar to the previous guidelines issued in 2012 except for one major change. In 2012, normal-risk women ages 30 to 65 could undergo “cotesting” with a Pap (cytology) test and a test for high-risk human papillomavirus (hrHPV) once every five years. Under the new recommendation, those women can undergo testing with the hrHPV test alone once every five years.

Other options for cervical cancer screening that were recommended in 2012 remain in place, including:

  • The first cytology test at age 21
  • Cytology testing every three years for women ages 21 to 29
  • The option of a cytology test with the hrHPV test once every five years for women ages 30 to 65
  • The option of a cytology test alone once every three years for women ages 30 to 65

“The current USPSTF recommendation statement preserves the greatest range of choices for practitioners and patients; in that sense, both will benefit,” said Lee A. Learman, MD, PhD, of Florida Atlantic University in Boca Raton, and Francisco A.R. Garcia, MD, MPH, of the College of Public Health at the University of Arizona in Tucson, in an editorial accompanying the guidelines.

Traditional Screening Methods

The traditional cervical cancer screening cytology test (known as the Pap test) has been in use for 75 years. The test examines the cells of the cervix for abnormalities. But in more recent years, a test has emerged that looks for infection with high-risk strains of a sexually transmitted virus called human papillomavirus (HPV).

Nearly all cases of are caused by HPV infection, according to the National Cancer Institute. There are about 12 high-risk HPV types.

The recommendation to allow some women to undergo just the hrHPV test alone was listed as “grade A” by the task force, meaning scientific evidence shows the prevention intervention has a significant impact, says task force vice chair Douglas K. Owens, MD, a general internist and associate director of the Center for Innovation to Implementation at the Veterans Affairs, Palo Alto Health Care System in California.

The new option of having the hrHPV test alone is based on research that shows cotesting did not improve the effectiveness of testing.

“We have better science to recommend that HPV alone is a very effective way to screen for cervical cancer,” Dr. Owens says. “We also had an analysis done, also published in this issue ofJAMA, that supports the HPV test alone as being a very effective option. For women who are 30 to 65, there are three very good options for them. Our view is all three of those are highly effective, and women should discuss with their physicians which option they want to pick.”

The hrHPV test is not available everywhere, he added.

“We want to ensure women have a good option, no matter where they receive care,” Owens says. “If you are in a place that has high-quality HPV testing, you may wish to opt for that.”

The USPSTF recommendations consider both the risks and benefits of screenings, Dr. Learman and Dr. Garcia said.

“Cotesting is slightly better than primary hrHPV testing at detecting precancerous lesions but is associated with increased tests and diagnostic procedures that may not benefit the patient and that have real costs to the health system,” they said.

Cost Is Not a Factor

The USPSTF does not consider cost in its recommendations, Owens says. Still, he says, recommendations graded A or B reflect services that are typically covered by insurance without a copay. The recommendations are not based on savings to the healthcare system.

“It’s important to understand that the USPSTF does not look at cost at all,” he says. “Our recommendations are based on clinical effectiveness.”

In 2012, the USPSTF for the first time presented the option of cervical cancer screening of cytology test and HPV testing, or cotesting, every five years for women ages 30 to 65. This recommendation was considered a significant step in expanding the interval for testing for the convenience of patients and without compromising safety.

Several other major health organizations also backed this recommendation, including the American College of Obstetricians and Gynecologists.

A Common but Treatable Cancer

Cervical cancer is the fourth most common cancer in women and is typically curable if detected at an early stage. Improved access to screening in the United States has led to a steep decline in both the incidence of the disease and deaths from cervical cancer over the past half century, say the authors of the guidelines.

But the incidence of cervical cancer and deaths from the disease are higher among poor and minority women and women living in remote or rural parts of the country who have limited access to screening and follow-up care.

“We know there are disparities in screening,” Owens says. “When cervical cancer occurs, it occurs mostly in women who have not been screened or who have not been adequately treated” for abnormalities detected during screening.

Cervical cancer is largely a preventable disease, Learman and Garcia state in their editorial. Children may now receive a two-dose HPV vaccine that is highly effective at preventing infection with the HPV strains that lead to cervical and anal cancer in women and penile, anal, and oropharyngeal cancers in men.






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New Guidelines Further Simplify Cervical Cancer Screening
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Date: 09.12.2018, 06:12 / Views: 74483