Cervical Cancer Screening Guidelines (2020) Created by the American Cancer Society. Although there is indication that the most influential factors in clinicians' cervical cancer screening practices are screening guidelines,158 in many health care settings, the current cervical cancer screening recommendations are not consistently followed, do not match women's preferences, or do not reflect efforts to educate women about new, recommended protocols.54 A national survey of different provider groups (family physicians, nurse practitioners, obstetricians and gynecologists, and certified nurse‐midwives) revealed considerable disparities and variation between and among provider groups in the use of cervical cancer screening tests.159 Despite recommendations against annual cervical cancer screening from major guideline developing groups, and many years since annual cytology screening was recommended, it is reported that annual cytology testing still is common.160, 161 Likewise, adoption of the 2012 preferred strategy of cotesting for women aged 30 to 65 years had been slow, although recent reports show an upward trend in cotesting among individuals aged 30 to 65 years,24, 25, 162 which varied geographically, from 27.5% in Utah to 49.9% in the District of Columbia.163 Not only is guideline adherence an enduring challenge; but, as noted previously, concerns about lack of universal access to preferred screening tests overall, and more so outside of urban and academic settings, have been borne out by national surveys of laboratories.22, 134, The GDG acknowledges the implementation challenges posed by recommending a new strategy for cervical cancer screening. This reduction in prevalence, along with potential reductions in CIN3+ prevalence (attributable to protection from vaccination), may increase the relative proportion of false‐positive screening results. The point of cervical cancer screening is to detect and treat precancer in order to prevent the development of cervical cancer. ETH
ASCCP c/o SHS Services, LLC 131 Rollins Ave, Suite 2 Rockville, MD 20852. , Dillner J, Elfström KM, et al. To examine the burden of disease overall and in age‐specific subgroups, the GDG used analyses conducted by the ACS Surveillance and Health Services Research program based on cancer incidence data from the Surveillance, Epidemiology, and End Results program and the National Program of Cancer Registries programs as provided by the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics.46-48 The GDG examined a range of disease burden indicators, including age‐specific incidence, mortality, and 10‐year incidence‐based mortality by age at diagnosis. Further efforts should be devoted to electronic health record interoperability across all clinical settings so that it will be easier for clinicians to obtain relevant medical and screening history data to identify persons who need to extend screening to meet cessation criteria or avoid overscreening because the medical record cannot be accessed. Schiffman
, Wolf AMD, Church TR, et al. The decision model used as a source of evidence44, 45 for the cervical cancer screening recommendation is a microsimulation model, in which individual women born in 1996 enter the model at age 9 years, begin screening at age 21 years, and are followed over their lifetimes.44, 45 The model simulates the natural history of the disease (ie, HPV infection, grades of CIN, and stages of invasive squamous cell cervical cancer) and tracks health services (ie, the number of screening tests, screening test outcomes, diagnostic procedures) and health outcomes (ie, life‐years gained, disease‐specific incidence and mortality). Cyto every 4 y from age 21 y/HPV every 5 y ages 25‐65 y, 5. Although screening tests are not expected to perform differently in these individuals, this limitation in the data is acknowledged. , Lacey MJ, Miller JD, et al. Cotesting is considered acceptable if HPV primary screening is not available. Based on the accumulation of evidence, the ACS now recommends primary HPV testing at a 5‐year interval as the preferred screening strategy for all individuals being screened, replacing the recommendation for cytology testing, with a switch to cotesting at age 30 years as the preferred strategy. Also of particular importance is identifying effective strategies that ensure women accumulate the history of normal screening examinations that would provide the opportunity to cease screening at age 65 years. The model generated 3 efficiency outcomes for comparing the tradeoff of harms and benefits associated with the different screening scenarios: 1) the incremental number of colposcopies per life‐year gained, 2) the incremental number of screening tests per life‐year gained, and 3) the incremental number of colposcopies per case of cervical cancer averted.44, 45 Strategies with a higher number of colposcopies and lower life‐years than an alternative strategy were considered inefficient and were eliminated from the calculation; all other strategies were considered efficient. Is a delay in the introduction of human papillomavirus‐based cervical screening affordable? Likewise, we are concerned about the very different findings from the US Preventive Services Task Force (USPSTF) 2012 and 2018 studies, showing a 7-fold difference in the 5-year risk of developing cervical cancer.11,12 Among the 25 USPSTF studies incorporated into that analysis, 84% used conventional Pap tests and 48% were from “developing countries”; only 2 were based on US data. 2020;24:102-131. 2021 Jan;30(1):5-13. doi: 10.1089/jwh.2020.8918. 7 Regular screening can help prevent cervical cancers and save lives. Working off-campus? To support effective test utilization, we hope that the contributions of various types of scientific studies and data will be evaluated together as diagnostic approaches aimed at reducing the incidence and consequences of cervical cancer evolve. There is strong consensus that successful screening and management of precursors of cervical cancer have led to substantial reductions in cervical cancer incidence and mortality. Finally, the American Cancer Society recently published its updated cervical cancer screening guidelines for 2020. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older, Population‐based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era, Protocol for Compass: a randomised controlled trial of primary HPV testing versus cytology screening for cervical cancer in HPV‐unvaccinated and vaccinated women aged 25‐69 years living in Australia, Cervical cancer in African American women: optimizing prevention to reduce disparities, Predictors of cervical cancer screening for rarely or never screened rural Appalachian women, Clinical impact and cost‐effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England. The recommendation for screening beginning at age 25 years with primary HPV testing applies to both vaccinated and unvaccinated women, based on the evidence of superior sensitivity and negative predictive value of HPV testing, the very low disease burden at young ages in unvaccinated and vaccinated women, the overall balance of benefits and harms, and the considerable implementation obstacles to any screening policy tailored to individual vaccination status. The GDG examined the evidence on disease burden, the efficacy and effectiveness of available screening tests, and the harms of screening in women aged <30 years. The overarching theme reflects a ‘risk-based’ strategy, rather than rigid focus on a particular result. For this guideline update, the model was adapted to include a screening start age of 25 years with the screening strategies previously evaluated. Screening recommendations for these subgroups and others potentially at higher risk than the general population because of immunosuppression have been the same as those for people living with HIV.126 More recently, Moscicki and colleagues have provided detailed guidance on screening various subgroups of non–HIV‐immunocompromised individuals.127. The other major change from the previous guideline is the recommendation that all average‐risk individuals with a cervix initiate screening for cervical cancer at age 25 years rather than 21 years, with primary HPV testing preferred. Additional burdens associated with a starting age of 21 years are the higher number of colposcopies because of transient infections and the associated stress along with the possible increased risk of adverse obstetrical outcomes in those who undergo cervical excisional procedures. Learn about our remote access options, Louisiana State University School of Public Health, New Orleans, Louisiana, Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia, Division of Environmental Health Sciences, University of Minnesota School of Public Health and Masonic Cancer Center, Minneapolis, Minneapolis, Public Health Sciences Division, the Fred Hutchinson Cancer Research Center, Seattle, Washington, Biostatistics, University of Washington Seattle, Seattle, Washington, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, University of Albany School of Public Health, Albany, New York, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, Duke Cancer Institute Center for Onco‐Primary Care, Durham, North Carolina, Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, Division of Geriatrics, University of California‐San Francisco, San Francisco, California, Division of Geriatrics, San Francisco VA Health Care System, San Francisco, California, Department of Health Policy and Management, Harvard T.H. By Michael D. Randell, MD, FACOG. Although the transition to primary HPV testing is occurring, the GDG is hopeful that the recommendation of a single test with a single screening frequency will facilitate broader adherence. In another study of the Kaiser Permanente Northern California population, investigators observed that the 5‐year risk of CIN3 after 1, 2, or 3 negative cotests in the 10‐year period before age 65 years was 0.034%, 0.041%, and 0.016%, respectively.112 No woman with 1 to 3 negative cotests was diagnosed with cervical cancer in the 5‐year follow‐up period. 2020 Jul 30. doi: 10.3322/caac.21628. Health care providers can play an important role in counseling patients who are uncomfortable with longer screening intervals or who have concerns about recommended starting and stopping ages. It is recognized that not all CIN 3 lesions will progress to cancer; many will regress. In addition, the authors did not separate the data for FDA-approved and off-label use of screening technologies. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. However, there are many ancillary issues that go beyond the screening recommendations that also are integral to successful outcomes, such as attention to individual risk of developing cervical cancer, quality assurance, elimination of access barriers, patient/clinician communication, management of abnormal findings, implementing new features of a guideline, and adoption of new technology. Start here to find evidence-based information on cervical cancer treatment, causes and prevention, screening, research, and statistics. Risk estimates were compared using screening and follow-up data from clinical trials (BD Onclarity registrational trials), a state registry (New Mexico HPV Pap Registry), and the Centers for Disease Control and Prevention’s (CDC’s) National Breast and Cervical Cancer Early Detection Program, a national program that includes many low-income and minority patients.” 2. Individuals with a cervix who were exposed to diethylstilbestrol in utero are at greatly increased risk of developing clear cell adenocarcinoma of the lower genital tract, a very rare cancer with the majority of the incidence occurring before age 30 years, but with elevated risk remaining into the 40s.128 In addition, those exposed to in‐utero DES are at increased risk of developing abnormal cells in the cervix and the vagina that are precursors of cancer (dysplasia, CIN, and squamous intraepithelial lesions).129, 130 Screening recommendations for these individuals have included pelvic examination with visualization of the cervix and vaginal wall, annual cytology, and consideration of colposcopy.103 Comprehensive screening recommendations for this group have not been recently updated, nor has consideration been given to the aging of the diethylstilbestrol‐exposed population. Nevertheless, in the US, an estimated 13,800 cases of invasive cervical cancer will be diagnosed, an estimated 4290 deaths from cervical cancer will occur in 2020, and disparities by race/ethnicity and socioeconomic status persist.1 These disparities, as well as the stabilization of incidence rates of squamous cell cervical cancer in non‐Hispanic whites and increasing rates of advanced cervical cancer in some age groups of non‐Hispanic whites,2 underscore the need for increased access and adherence to recommended screening practices for both primary and secondary prevention.3, 4, Recommendations for cervical cancer screening have evolved over the years, influenced by greater understanding of the natural history of the disease, the causal role of infection with high‐risk human papillomavirus (hrHPV) types, and changing screening test technology. 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