THE U.S. PREVENTIVE SERVICES TASK FORCE has posted a draft recommendation statement and draft evidence review on screening for cervical cancer. The Task Force recommends that primary care clinicians screen for cervical cancer in women ages 21 to 29 every 3 years with cervical cytology, more commonly known as the Pap test. For women ages 30 to 65, the Task Force recommends either screening with cervical cytology alone every 3 years or screening with high-risk human papillomavirus testing alone every 5 years. This is a grade A recommendation.
The Task Force recommends against screening women younger than age 21, women older than age 65 years who have been adequately screened previously, and women at any age who do not have a cervix. These are grade D recommendations.
These recommendations apply to women, regardless of sexual history, who have a cervix and show no signs or symptoms of cervical cancer. These recommendations do not apply to women who are already at high risk for the disease, including those who have been diagnosed with a high-grade precancerous cervical lesion or have a weakened immune system (such as women who are HIV-positive).
About the Draft Recommendations
Carol Mangione, MD, MSPH
“CERVICAL CANCER is highly curable when found and treated early,” says Task Force member Carol Mangione, MD, MSPH. “Most cases of cervical cancer occur in women who have not been regularly screened or treated. Therefore, making sure all women are adequately screened and treated is critical to reducing deaths from cervical cancer.”
“The Task Force looked at the evidence on the effectiveness of different screening tests and intervals based on age and found that after age 30, the Pap test and [high-risk human papillomavirus] tests are both effective for cervical cancer screening,” says Task Force member Maureen G. Phipps, MD, MPH. She added “Women ages 30 to 65, therefore, have a choice between the Pap test every 3 years or [high-risk human papillomavirus] test every 5 years.”
Maureen G. Phipps, MD, MPH
The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at www.uspreventiveservicestaskforce.org. Comments can be submitted from September 12 through October 9, 2017, at www.uspreventiveservicestaskforce.org/tfcomment.htm.
WHAT ARE THE GRADES OF RECOMMENDATION?
Grade A: The USPSTF recommends this service. There is high certainty that the net benefit is substantial. This service should be offered or provided to individuals.
Grade B: The USPSTF recommends this service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. This service should be offered or provided to individuals.
Grade C: The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. This service should be offered or provided to selected patients depending on individual circumstances.
Grade D: The USPSTF recommends against the service. There is moderate or high certainty that the harms outweigh the benefits. This service should be discouraged.
USPSTF TASK FORCE
THE TASK FORCE is an independent, volunteer panel of national experts in prevention and evidence-based medicine.
Dr. Mangione is Chief of the Division of General Internal Medicine and Health Services Research and the Barbara A. Levey, MD, and Gerald S. Levey, MD, endowed Chair in Medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). She is also Professor of Public Health at the UCLA Fielding School of Public Health and Director of the UCLA/Drew Resource Center for Minority Aging Research/Center for Health Improvement of Minority Elderly.
Dr. Phipps is Department Chair and Chace-Joukowsky Professor of Obstetrics and Gynecology and Assistant Dean for Teaching and Research in Women’s Health at the Warren Alpert Medical School of Brown University. In addition, she is Chief of Obstetrics and Gynecology at Women & Infants Hospital of Rhode Island and Executive Chief of Obstetrics and Gynecology at Care New England. ■