August 23, 2018

USPSTF says many women don't need both a Pap and an HPV test

Daily Briefing

    The United States Preventive Services Task Force (USPSTF) for the first time is recommending that women ages 30 to 65 can pick between either a Pap test or a human papillomavirus (HPV) test to screen for cervical cancer, rather than receiving both tests, Reuters reports.

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    USPSTF made the recommendation in final guidance published Tuesday in JAMA.

    Final guidance details

    The recommendation updates the panel's 2012 guidance, which recommended women ages 30 to 65 receive co-testing—both a Pap test and HPV test—every five years. USPSTF in its new recommendation said women ages 30 to 65 can still opt to be co-tested every five years, but it recommended that otherwise healthy women ages 30 to 65 instead receive either a Pap test every three years or an HPV test every five years.

    USPSTF made the new recommendations in light of research suggesting that co-testing can lead to more false alarms than either test on its own, without any additional benefit for screened women.

    Aside from the new recommendations for women ages 30 to 65, the guidance affirms USPSTF's 2012 cervical cancer screening recommendations for other age groups. The guidance recommends that:

    • Women under age 21 do not receive cervical cancer screenings, unless they have an HIV infection or another condition that compromises their immune systems;
    • Women ages 21 to 29 receive a Pap test every three years—but not an HPV test, which USPSTF said in that age group can lead to overtesting and overdiagnosis; and
    • Women over age 65 do not receive cervical cancer screenings unless they are deemed high-risk, such as those who do not have enough negative screenings in their medical history.

    The new guidance aligns USPSTF's stance on cervical cancer screening more closely with guidance from the American College of Obstetricians and Gynecologists, the American College of Physicians, and other medical organizations, which recommend either the Pap test every three years or both the Pap test and HPV test every five years. However, USPSTF's guidance marks the first that recommends the HPV test without the Pap test.

    Reaction

    Debbie Saslow, senior director for HPV-related and women's cancers at the American Cancer Society, said, "I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone," noting that research has shown the HPV test could be more effective at detecting cervical cancer than the Pap test.

    Carol Mangione of the David Geffen School of Medicine at the University of California-Los Angeles, who is a member of USPSTF, said, "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." Mangione added, "A 5-year screening interval for HPV testing alone or co-testing offers the best balance of benefits and harms."

    George Sawaya of the University of California-San Francisco, who authored an editorial accompanying the final guidance, said the new recommendation could help to reduce the number of false-positive tests that occur in women who do not actually have cervical cancer. He said, "While harms of screening are unavoidable, they can be minimized by screening less frequently and by using tests with fewer false alarms." He continued, "We don't want to turn a lot of well women into patients" (Rapaport, Reuters, 8/21; Harris, "Shots," NPR, 8/21).

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