What Are the Proposed New Cervical Cancer Screening Guidelines?

Baptist Health Cancer Care experts are weighing in on proposed new guidelines for cervical cancer screenings. In December, the U.S. Preventive Services Taskforce (USPSTF) recommended continuing screening for cervical cancer every three years with cervical cytology alone in women ages 21 to 29 years. For women ages 30 to 65 years, it recommended high-risk human papillomavirus (HPV) primary screening every five years, either with clinician- or patient-collected samples.

As an alternative to HPV primary screening for women ages 30 to 65 years, the USPSTF has recommended continued screening every three years with cervical cytology alone, or “co-testing” by screening every five years with high-risk HPV testing in combination with cytology. The USPTF is considering making HPV testing alone every five years the “preferred” option but this has not yet been decided.

Cervical cancer screening is not routinely recommended in patients over 65, according to Thomas Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health, “Unless they have a previous history of treatment for cervical dysplasia or other specific risk factors for cervical dysplasia such as an immunocompromised state or HIV disease, cervical screening past age 65 isn’t recommended,” he says.

What cervical cancer screenings do I need?

Dr. Morrissey emphasizes that the updated USPTF screening guidelines have not yet been finalized. “These are only draft guidelines at this point but they do reflect the latest thinking from leading experts in the field.”

In the meantime, Dr. Morrissey advises, you should always discuss your own circumstances with your gynecologist or primary care physician. “They can help you decide on the best screening strategy for you, taking these guidelines into account,” he says. “The most important thing is to follow one of the accepted screening recommendation schedules and to continue routine follow-ups with a gynecologist.”

What causes cervical cancer?

According to John Paul Diaz, M.D., chief of gynecologic oncology at Miami Cancer Institute, also part of Baptist Health Cancer, almost all cases of cervical cancer are caused by HPV, a viral infection spread primarily through sexual contact. It can also be transmitted from infected mother to baby during childbirth.

“HPV can also lead to vulvar cancer and vaginal cancer in women and a number of head and neck cancers in both men and women,” Dr. Diaz says. More than 85 percent of U.S. adults have been exposed to HPV at some point in their lifetime, he adds.

Symptoms of cervical cancer can include unusual vaginal bleeding, such as after intercourse, after menopause or between periods; longer or heavier than usual menstrual periods; vaginal discharge; and pelvic pain or pain during intercourse. If you experience symptoms, see your doctor as soon as possible.

Can cervical cancer be prevented?

Dr. Diaz notes that cervical cancer was once a leading cause of cancer death for women in the U.S. but the number of deaths due to cervical cancer has fallen by a third over the past three decades.

“While on the decline, cervical cancer is diagnosed in approximately 14,000 women each year and that is 14,000 women too many,” Dr. Diaz says. “Cervical cancer is a completely preventable disease that could and should be eradicated. Between the HPV vaccine and the screenings we have available, we can find cervical cancer in its early stages when it is most treatable and, most importantly, we can prevent this disease.”

Dr. Diaz credits the decrease in cervical cancer to the advent of the HPV vaccine, which was first approved in 2006 for children ages 9 and up and later approved for use in women and men through the age of 45.

“It’s been an incredible advancement in medicine,” Dr. Diaz says of the HPV vaccine. “It is highly effective and is up to 99+ percent protective against the development of severe cervical dysplasia or cancer as well as cancers of the vulva, vagina, anus and male genitalia.” And after 20-plus years of follow-up studies, he says there has been no evidence of waning effectiveness or the need for booster immunization.”

Are Pap smears the only way to test for cervical cancer?

Dr. Morrissey at Lynn Cancer Institute says that HPV testing methods have improved to the point where HPV testing alone has equivalent sensitivity to the traditional Pap smear.

Thomas Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health

“However, traditional Pap smears have a higher ‘false-positive’ rate due to abnormalities in the cells that may be caused by irritation or other infections and not by precancerous changes,” Dr. Morrissey notes. “With the most modern techniques of HPV testing, using both methods together at this point does not significantly improve detection of cervical cancer or precancer compared to HPV testing alone,” he explains.

In addition, Dr. Morrissey says that testing has now been developed that allows patients themselves to collect a specimen for HPV testing by using a vaginal swab. When it comes to detecting “high-risk” strains of HPV virus, he says self-collection appears to have similar detection rates to samples obtained by gynecologists during a pelvic exam. “The new USPSTF recommendations may incorporate HPV testing by patient self-collection as an acceptable screening method,” he adds.

Cervical cancer screening remains a crucial and highly effective tool for the early detection of cervical cancer, Dr. Morrissey says. “It also allows for the detection of precancerous changes, which if left untreated can become cancer.”

Learn more about cervical cancer treatments available at Lynn Cancer Institute and Miami Cancer Institute.