New guidelines advise less-frequent Pap tests

USPSTF cervical cancer screening guidelines recommend delaying the first Pap test to age 21 and extending the interval between screens to 3 to 5 years.

The USPSTF recommendations are in line with recommendations from ACOG and other organizations.

Scientific evidence does not support annual Pap tests in most women, according to new cervical cancer screening guidelines issued by the United States Preventive Services Task Force (USPSTF) on March 14. Screening need not start until age 21, even in sexually active women, and the guidelines also recommend combined screening with Pap smears plus human papillomavirus (HPV) testing every 5 years for women over 30. Women over 65 who have had prior adequate screening and are not at high risk for cervical cancer need not be screened.

The Task Force changed its recommendations because of overwhelming evidence showing that cervical cancer is relatively slow growing. In women who test negative, development of advanced cancer is highly unlikely in the next few years. Most cases of cervical cancer occur in women who are not screened at all. Further, the harms produced by both testing and treatment of screening-detected disease outweigh the potential benefit and may lead to other harms.

HPV testing is now required in women younger than 30 because the infection is common in younger women and often resolves on its own without increasing cancer risk. The panel agreed that lacking long-term data on HPV vaccination, women who have been inoculated should continue to be screened.

Women older than 65 do not require regular screening unless they have a history of precancerous lesions. It’s also unnecessary in hysterectomized women who have had their cervixes removed and who do not have a history of cervical intraepithelial neoplasia (CIN) grade 2 or 3 or cervical cancer; women who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer; those who had in utero exposure to diethylstilbestrol; and those who are immunocompromised.

The new recommendations are in line with those issued by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, the American Society for Clinical Pathology, and the American College of Obstetricians and Gynecologists.

Read other articles in this issue of Special Delivery.