Screening for Cervical Cancer
- Study type
- Clinical guideline
- Study name
- USPSTF 2018
- Design
- Clinical guideline recommendation statement based on an evidence review (clinical trials and cohort studies) and a decision analysis model
- Source
- JAMA · 2018
In plain words
Regular screening can find precancerous changes of the cervix or cancer early and greatly lower the risk of getting it and of dying from it. According to this recommendation, women aged 21 to 29 should have a cytology test (Pap smear) every 3 years, and women aged 30 to 65 can choose one of three options: cytology every 3 years, an HPV test every 5 years, or both together every 5 years. Screening is not needed for women under 21, women over 65 who have had enough screening before and are not at high risk, or women whose cervix was removed for reasons other than a high-grade precancerous lesion or cancer. Make the final decision with your doctor.
Key points
Key guideline recommendations
- A
Screening for cervical cancer every 3 years with cervical cytology alone is recommended in women aged 21 to 29 years.
- A
Screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) is recommended in women aged 30 to 65 years.
- D
Screening for cervical cancer is recommended against in women younger than 21 years.
- D
Screening for cervical cancer is recommended against in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
- D
Screening for cervical cancer is recommended against in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer.
Study population
Women at average risk of cervical cancer; age groups under 21 years, 21 to 29 years, 30 to 65 years and over 65 years, and women who have had a hysterectomy with removal of the cervix.
Endpoints
The evidence review focused on trials and cohort studies comparing screening with high-risk HPV (hrHPV) testing alone or together with cytology (cotesting) against cervical cytology alone. A decision analysis model was also commissioned to evaluate the ages to start and stop screening, the optimal screening interval, the effectiveness of different strategies and their associated benefits and harms.
Safety and side effects
According to the abstract, the harms of cervical cancer screening in women aged 30 to 65 years were assessed as "moderate". Further details on harms are not given in the abstract and are in the full text of the statement.
Clinical significance and place in guidelines
This statement updated the 2012 USPSTF recommendation and, for women aged 30 to 65 years, added primary screening with hrHPV testing alone every 5 years as a recommended option (grade A) alongside cytology and cotesting. The recommendations apply to women at average risk, and their current status in national and international guidelines (and more recent versions) should be checked.
Limitations
The abstract does not mention limitations of the evidence; details are in the full text of the statement. These recommendations are for women at average risk, and some of the findings are based on a decision analysis model.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.