Cervical Cancer Screening Every 5 Years OK

After reviewing the latest data on the benefits and risks of human papillomavirus (HPV) and Pap testing, the U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on cervical cancer screening. They offer many women a new option: screening every 5 years with high-risk HPV testing (JAMA 2018;320:674–86).

“Women between the ages of 30 and 65 now have a choice between three very good options,” says Carol Mangione, MD, of the University of California, Los Angeles, who was a member of the committee that developed the recommendations. “They can continue to get a Pap test every 3 years, get high-risk HPV testing every 5 years, or do co-testing, where both tests are performed, every 5 years.”

For women who are at average risk for cervical cancer, “the science is very clear—screening every 3 to 5 years is perfectly safe,” says Mark Stoler, MD, of the University of Virginia in Charlottesville, who was not involved in developing the recommendations.

“The beauty of these recommendations is that labs are already equipped to perform high-risk HPV testing,” he adds. Indeed, many healthcare providers already perform both Pap and HPV tests, so the transition to HPV testing alone should be easy for women who prefer that option.

However, some clinicians and their patients may be skeptical about screening only every 5 years. To them, it may not be obvious why less frequent testing is beneficial. Mangione emphasizes that the USPSTF recommendations consider solely medical risks and benefits, and not costs. Familiarizing healthcare providers with the downsides of screening too often may help promote acceptance of the guidelines. “Screening too frequently leads to harm—mainly too many office visits and too many unnecessary biopsies and other procedures,” says Stoler.

For women outside the 30- to 65-year-old age range, cervical cancer screening recommendations remain unchanged. Women ages 21 to 29 should receive Pap tests every 3 years. Groups that do not need to be screened include women younger than 21, and women older than 65 who received three consecutive negative Pap tests or two consecutive negative Pap plus HPV tests in the last 10 years. Finally, women who are at increased risk of cervical cancer—due to a high-grade precancerous lesion, for example—may need more frequent screening.

Although screening is essential for early detection, Stoler emphasizes that driving down the prevalence of cervical cancer will require higher HPV vaccination rates. In the United States, “only half of kids are fully vaccinated, and the goal is 90%,” he says. “All the children in this country should get the HPV vaccine.” –Kristin Harper

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