People with a cervix may notice a change on their next OB-GYN visit thanks to new guidelines for cervical cancer screening. These new rules aim to reduce stress and increase detection of the virus that causes most cervical cancers.
The updated cervical cancer screening requirements of the American Cancer Society now suggest that people with a cervix undergo a primary human papillomavirus (HPV) test, rather than a Pap test, every five years, beginning at age 25 and continuing through age 65. More frequent Pap tests (every three years) are still considered acceptable tests for offices without access to primary HPV tests. Previous ACS guidelines, released in 2012, advised that evaluation begin at age 21.
“Women can start (testing) later. They can do it less often,” said Dr. Alexi Wright, director of gynecologic oncology outcomes research at the Dana-Farber Cancer Institute in Boston, who was not involved in the development of updated recommendations. “The test is (detecting) the virus that causes cervical cancer and whether a woman has an infection or not. It allows us to better understand her risk of developing cervical cancer.”
The recommendations of the US Preventive Task Force and the American College of Obstetricians and Gynecologists (ACOG) differ from the ACS guidelines. They encourage Pap tests every three years from age 21 to 29, then the joint Pap test and primary HPV test of 30 to 65 every five years, or just one Pap test every three years.
In a statement shared with TODAY, ACOG said they hope to review the new ACS recommendations to determine if they should update their clinical guidance.
“Meanwhile, ACOG affirms our current cervical cancer screening guidelines, which encompass all three cervical cancer screening strategies (high-risk human papilloma virus test alone, cervical cytology alone, and co-test).” , wrote Dr. Christopher M. Zahn, vice president of practice activities at ACOG. “… Current screening guidelines reflect a balance of benefits and potential harms and support shared decision making between patients and their physicians.”
Both Pap tests and HPV tests require cells collected around the cervix, so the collection experience remains similar.
Pap tests detect changes in the cells of the cervix and are unreliable. Wright said there is a 50-50 chance that a major change will be lost or cells will be incorrectly marked as abnormal. But the primary HPV test detects the virus, which accounts for 99% of cervical cancers. If the tests are positive, doctors can better understand the patient’s cancer risk.
“The update builds on decades of studies comparing the effectiveness of HPV testing compared to (the Pap tests),” Debbie Saslow, managing director of HPV and GYN cancers at the American Cancer Society, told TODAY, via email.
This provides relief for people, as they anticipate fewer unclear and stressful Pap test results.
“Giving women more security, with more accurate testing, can be really helpful,” said Wright. “There can be a lot of anxiety, which is severe, around tests that are considered abnormal but cannot actually be significantly abnormal.”
While the first evaluation at 25 instead of 21 might seem like it might miss younger people at risk for cervical cancer, Saslow said that’s not true. Less than 1% of cervical cancers are detected before the age of 25, which is equivalent to about 130 a year.
“This number is decreasing thanks to the HPV vaccine,” he said. “These cases have not decreased as a result of screening, and the numbers are similar in countries that start screening later. Screening is simply not beneficial at this age.”
Over the past 40 years, the rate of cervical cancer and deaths from it have decreased significantly, according to the Centers for Disease Control and Prevention. While screening has helped, the HPV vaccine has contributed to the decline. When it comes to teenage girls, wart-causing cancer infections and strains of HPV fell 86%, and among young women, these infections decreased 71%, according to the CDC. The latest estimates show that 60% of adolescent girls and 42% of adolescent boys have received one or more doses of the HPV vaccine. Wright urges parents to vaccinate their children to prevent cancers of the head, neck, cervix, penis, and anal.
“This is a vaccine designed to prevent cancer,” said Wright. “My hope is that by combining vaccination, screening and treatment it can be eradicated (the cancers that cause HPV) in this country.”
This story was updated on July 30, 2020 to include a comment from the American College of Obstetricians and Gynecologists (ACOG) and current HPV vaccination rates.
