U.S. Cancer Groups Release Their Own Cervical Cancer
WEDNESDAY, Oct. 19 (HealthDay News) -- Three leading U.S. cancer
groups have proposed new guidelines for cervical cancer testing for
women, including when to start screening for sexually active young
women, extending intervals between screenings and in some cases,
supplementing the traditional Pap test with human papilloma virus
The American Cancer Society, the American Society for Colposcopy
and Cervical Pathology and the American Society for Clinical
Pathology joined to create the guidelines, which advise women to
get fewer screenings over their lifetime and that women 65 and
older with a history of normal Pap tests can stop altogether.
The guidelines also call for combination HPV-Pap testing in
women aged 30 and older, placing stronger emphasis on HPV testing
than another set of guidelines officially released at the same
time, from an independent and influential government panel.
That government panel, the U.S. Preventive Services Task Force
(USPSTF), is reaffirming the Pap test as the best way for women
aged 21 to 65 to spot cervical cancer, saying it "substantially"
cut the number of deaths from the disease.
The USPSTF remains cautious on the use of the human
papillomavirus (HPV) blood test to detect cervical cancer. It moved
against the use of the HPV test in women under the age of 30, and
said that evidence was still lacking on its risks vs. benefits to
recommend it in women aged 30 and older.
The three cancer groups said they coordinated Wednesday's
release with the USPSTF to "enable stakeholders to consider both
sets of recommendations concurrently with the goal of creating
consistent guidance that will lead to less confusion for providers
and the public."
The USPSTF looks over the latest evidence-based research to come
to its recommendations, which are closely watched by physicians and
insurance companies. The panel's decisions are often controversial:
in 2009, it recommended against annual mammograms for women in
their 40s, and just last week it said the risks of the
prostate-specific antigen (PSA) blood test outweigh its benefits in
detecting prostate cancer.
The results of two evidence reviews by the USPSTF on cervical
cancer screening conducted by the panel were published Oct. 18 in
Annals of Internal Medicine.
"Cervical cancer screening is a public health success story," said study author Dr. Evelyn P. Whitlock, a preventive medicine specialist at Kaiser Permanente Center for Health Research in Portland, Ore. "The number of women dying from cervical cancer has been cut in half due to regular screening."
But "there are still about 12,000 women diagnosed with cervical
cancer every year and 4,000 women die from cervical cancer each
year," she said. "We need to continue to improve so we have a fully
successful screening program. We are trying to improve on success
and that is a pretty high bar."
To compare the Pap against the HPV test, the researchers
analyzed four studies they deemed of fair-to-good quality,
encompassing nearly 142,000 women.
HPV causes many cases of cervical cancer, and incorporating HPV
testing into cervical cancer screening programs may catch more
at-risk women. However, the researchers found that HPV testing, on
its own, yields too many false positives which results in
unnecessary testing, anxiety and health care costs for many
According to the new report, HPV testing is more sensitive, but
less specific than the Pap test, Whitlock said. "This means that
more women who have nothing wrong with them will test positive with
HPV testing, and this may cause potential harm," she said.
During a Pap test, a doctor scrapes cells from a woman's cervix
and a laboratory examines these cells for abnormalities. When a
type of Pap test called a liquid-based cytology test is performed,
testing for HPV can be performed at the same time.
Dr. Elizabeth A. Poynor, a gynecologic oncologist and pelvic
surgeon at Lenox Hill Hospital in New York City, said this is a
work in progress. "We are still learning how to incorporate HPV
testing into our current algorithm," she said. "Women need to ask
their physician which screening strategy is best for them based on
their personal risk factors."
Another review article looked at the appropriate ages to
initiate and discontinue cervical cancer screening. The authors
conclude that screening for cervical cancer should continue to
begin at age 21. If a woman age 65 or older has had an adequate
number of normal Pap test results and is not considered high risk
for cervical cancer, she can stop screening at age 65. Older woman
who are considered at high risk for cervical cancer include those
who have had previous high-grade cervical lesions or a history of
Dr. Mark Wakabayashi, chief of gynecologic oncology at the City
of Hope Cancer Center in Duarte, Calif., said that the real issue
is that some women never get either test. "The ones who don't get
Pap tests are the ones who are dying from cervical cancer," he
said. "We are trying to be more cost-effective with our screening
for cervical cancer, but we don't want to mess with success."
The American Cancer Society provides more information on
cervical cancer screening.
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