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 In both tests, doctors must scrape cells from the cervix for
analysis. But the advice from the U.S. Preventive Services Task
Force (USPSTF) is designed to reduce "false alarms" that lead to
invasive follow-up tests and unnecessary treatment.
The new guidelines also recognize that risks and benefits of
cervical cancer screening change as women age.
Women under 21 shouldn't get screened at all, the Task Force says.
In young women, HPV infection usually clears up on its own and is
unlikely to cause cancer.
From 21 to 29, women should get screened every three years with a
Pap test, which detects abnormal cells but cannot detect HPV.
Older women have a choice: from age 30 to 65 they can get Pap tests
every three years. Or, they can get screened every five years with a
test that looks for the high-risk types of HPV that cause cervical
cancer. Or they can opt for "co-testing" every five years with both
tests.
"Screening more frequently than every five years does not
substantially improve the benefits for women - it simply increases
the number of screening tests and follow-up procedures women
receive," said Dr. Carol Mangione of the David Gaffe School of
Medicine at the University of California Los Angeles.
"A 5-year screening interval for HPV testing alone or co-testing
offers the best balance of benefits and harms," Mangione, a Task
Force member, said by email.
Doctors used to recommend annual Pap tests. But studies show that
less frequent screening can still catch cancer early and that HPV
testing needn't be done at the same time as a Pap test, said Dr. Joy
Melnikow, of the University of California, Davis, by email. Melnikow
coauthored an evidence review for the USPSTF.
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Because HPV tests only detect the virus in the cervix, and not
precancerous or cancerous cells, a positive test must be followed
with a Pap or other tests.
The chief advantage of HPV testing is less frequent pelvic exams,
said Dr. Lee Learman, author of an editorial published with the new
guideline in JAMA.
Over time, as more people get a relatively new vaccine to prevent
HPV, women may need cervical cancer screening even less often,
Learman, of Florida Atlantic University in Boca Raton, said by
email.
In the meantime, the new guidelines may help reduce the number of
tests that are positive for abnormal cells or HPV in women who don't
actually have cancer, said Dr. George Sawaya of the University of
California, San Francisco, author of a second editorial.
"While harms of screening are unavoidable, they can be minimized by
screening less frequently and by using tests with fewer false
alarms," Sawaya said by email. "We don't want to turn a lot of well
women into patients."
SOURCE: http://bit.ly/2KoetVH JAMA, online August 21, 2018.
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