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U.S. Cancer Groups Release Their Own Cervical Cancer Screening Guidelines
Date:10/19/2011

By Denise Mann
HealthDay Reporter

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 (HPV) testing.

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 the 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 women.

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 cervical cancer.

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."

More information

The American Cancer Society provides more information on cervical cancer screening.

SOURCES: Evelyn P. Whitlock, M.D., MPH, preventive medicine specialist, Kaiser Permanente Center for Health Research, Portland, Ore.; Mark Wakabayashi, M.D., chief, gynecologic oncology, City of Hope Cancer Center, Duarte, Calif,; Elizabeth A. Poynor, M.D., gynecologic oncologist and pelvic surgeon, Lenox Hill Hospital, New York City; Oct. 18, 2011, Annals of Internal Medicine; Oct. 19, 2011, news release, American Cancer Society


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