The American College of Physicians (ACP) has released clinical advice to reduce the overuse of cervical cancer screening in average risk women without symptoms. The study “Cervical Cancer Screening in Average Risk Women” was published in Annals of Internal Medicine and is signed by two organizations: the American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology.
“ACP’s advice for cervical cancer screening is designed to maximize the benefits and minimize the harms of testing. Historically, physicians have low adherence to cervical cancer screening recommendations, beginning screening too early, performing screening too often, and continuing to screen women at low risk, either by age criteria or after hysterectomy with removal of cervix,” explained David Fleming who is the president of ACP.
ACP explains that physicians should begin screening average risk women for cervical cancer by the time they are 21 years of age and repeat it once every 3 years. Using a combination of cytology and HPV (human papillomavirus) testing, average risk women should be screened once every 5 years if they are older than 30 years of age. Average risk women who are older than 65 years should stop being screened for cervical cancer if they had 3 consecutive negative cytology results or 2 consecutive negative cytologies and additional HPV test results within 10 years, and if the most recent test was performed within 5 years.
Average risk women who are younger than 21 years of age should not be screened with cytology more than one time each 3 years for cervical cancer and HPV testing should not be performed in average risk women younger than 30 years or any average risk women of any age that had had a hysterectomy with removal of the cervix.
Screening average risk women without any symptoms for cervical cancer might harm women and make them feel discomfort with colposcopies and speculum examinations, bleeding, pain, excisional treatments, cervical biopsies, prolonged surveillance, adverse obstetrical outcomes and false positive testing.
George F. Sawaya from the University of California, San Francisco Center for Healthcare Value said, “By following ACP’s Best Practice Advice, physicians can practice high value care by reducing over-screening, overtreatment, and unnecessarily higher costs.”
Cervical cancer is thought to be related to high-risk types of HPV and appears to be the long-delayed result of infection with any of these HPV types. The possibility of a woman revealing abnormal test results varies according to the tests used and the patient’s age.
About 30%, 12% and 5% of women aged between 20-24, 30-34 and 60-64 years old, respectively, will test positive for HPV. Furthermore, 13%, 7% and 3% of women aged between 21-24, 30-34 and 60-64 old will have abnormal cytology results. In patients who are younger than 21 years of age, cytological abnormalities are common, however clinically relevant cervical lesions are quite rare.