Matthew McKenna, MD, previously served as a member of the GDG and participated in the early stages of deliberation on this cervical cancer screening guideline. Screening can enhance early detection and vaccination can decrease the risk of developing cervical cancer. Women with both negative HPV and cytology are less likely to develop CIN 3+. Also, compared with the strategy of cytology alone beginning at age 21 years and switching to cotesting at age 30 years, starting screening with primary HPV testing at age 25 years showed a 13% gain in cervical cancer cases prevented and a 7% gain in cervical cancer deaths prevented, with similar life‐years gained (64,193 vs 64,194, respectively) and with only 9% more colposcopies but 45% fewer tests (HPV or cytology) required overall. These criteria do not apply to individuals who are currently under surveillance for abnormal screening results. ACCSP Cervical Cancer Screening …   EEL Abbreviation: FDA, US Food and Drug Administration. A majority of cases of invasive cervical cancer occur in individuals who have never been screened or have not been adequately screened.64, 131 According to the 2018 National Health Interview Survey data, 90% of respondents aged 30 to 39 years reported being up to date with screening; this rate declines to 80% among women aged 50 to 65 years.132 The underscreening of those aged 50 to 65 years is particularly concerning because individuals with a 10‐year history of normal screening results may discontinue screening after age 65 years. In addition to greater uptake of screening, the reported advantages of HPV self‐sampling include convenience, privacy, less embarrassment and anxiety, ease of use, and less discomfort and pain compared with in‐office specimen collection.143, 146, 149 The method of dissemination of self‐sampling test kits has an impact on screening uptake—the most effective impact is achieved with HPV self‐sampling kits offered door‐to‐door by health workers, whereas mailing kits directly to the homes or requiring women to pick up their own kits is less effective in achieving screening uptake. As noted above, the growing prevalence of individuals who receive timely vaccination against hrHPV types will result in a decrease in the prevalence of HPV infections, which, in turn, will influence management recommendations. Finally, although anatomical changes associated with older age are purported to reduce the sensitivity of screening, no studies were identified that examined differential performance of cytology, primary HPV testing, and cotesting in older individuals. Cotesting is considered acceptable if HPV primary screening is not available. With any guideline update, it is important to re‐examine the foundation of past recommendations and determine whether they are still relevant based on a current assessment of the burden of disease (Figs. Carlo A. Liverani, Jacopo Di Giuseppe, Luca Giannella, Giovanni Delli Carpini, Andrea Ciavattini, Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature, Journal of Oncology, 10.1155/2020/8887672, 2020, (1-14), (2020). In 2019, the ASCCP updated consensus guidelines for the management of screening abnormalities, which are available as an open‐access document on the Journal of Lower Genital Tract Disease website.21 Clearly defined risk thresholds based on the results of HPV tests, alone or in conjunction with cytology, are used to guide management (more or less frequent surveillance, colposcopy, or treatment; or return to routine screening).21 Risk estimation tables and decision aids also have been provided to estimate a patient's risk of having or developing CIN3+ (as a surrogate endpoint for developing cervical cancer), based on a current screening test result and previous screening tests and biopsy results. The available evidence suggests that few persons aged >65 years are likely to develop new infections that will follow a life‐threatening course.115, 116 This is supported by a sensitivity analysis done for one modeling study demonstrating a low absolute risk even assuming double the current HPV prevalence in older women (see Modeling Age to Stop Screening, below).113 The GDG reaffirms the conclusion of the 2012 guideline that, once screening is discontinued, it should not resume for any reason, even if an individual reports a new sexual partner.5. Learn more. People aged 50 to 64 receive invitations e… Schiffman By boosting human papillomavirus vaccination, cervical cancer screening, diagnosis, and treatment, the World Health Organization (WHO) hopes to slash new cervical cancer cases by 40% and deaths by 5 million by 2050. Any queries (other than missing content) should be directed to the corresponding author for the article. The highest proportion of unscreened women within the ages recommended for screening is among women aged 60 to 65 years.4, The GDG examined evidence of differential disease burden between regularly screened, underscreened, and unscreened women. The ACS also will work with key organizations to overcome the barriers to screening that contribute to the persistence of avoidable morbidity and mortality from cervical cancer. For women aged ≥50 years with successive negative HPV tests as part of the cotest, regardless of cytology results, the decline in the 5‐year CIN3+ risk was similar (0.073%, 0.042%, and 0.027%, respectively); and the CIN3+ risk associated with an HPV‐negative test nearly matched the performance of a negative cotest, regardless of the cytology result. In the KPNC study, these women were at 16% lower risk than those who were HPV negative alone (3.2 vs 3.8 per 100,000 women per year).9,10 The differences observed between our analysis and the similar KPNC data analysis raise questions about the generalizability of regional findings to national guidelines. If you are aged 30–65 years—You can choose one of … Prepared for the March 8, 2019 meeting of the Microbiology Devices Panel of the Medical Devices Advisory Committee (see FDA 2019. For the update of the cervical cancer screening guideline, the GDG chose to use 2 reports commissioned by the USPSTF for its 2018 cervical cancer screening update as sources of evidence to inform recommendations: 1) a systematic evidence review on cervical screening conducted by the Kaiser Permanente Research Affiliates Evidence‐Based Practice Center,4, 43 and 2) a decision analysis based on a mathematical disease‐simulation model that was produced by researchers at the Center for Health Decision Science of the Harvard T.H. Current members are: Timothy R. Church; Ruth Etzioni, PhD; Christopher R. Flowers, MD; Elizabeth T. H. Fontham, DrPH (Co‐chair); Carmen Guerra, MD; Abbe Herzig, PhD (Patient Representative); Kevin C. Oeffinger, MD (Chair); Ya‐Chen Tina Shih, PhD; Louise C. Walter, MD; and Andrew M. D. Wolf, MD. The updated guidelines recommend that women begin regular cervical cancer screenings with an HPV test only starting at 25, which is a few years later than previously recommended. This argument is based on the detection of cervical cancer as the clinical end point and relied on real-world data from a large reference laboratory to substantiate this conclusion. The inclusion of cotesting and cytology‐only testing as screening strategies in this update should be viewed as provisional: an acknowledgment of the variability that may exist in access to preferred testing technology across health care settings in the United States, and the time that will be required for primary HPV testing to replace cotesting and cytology‐only testing in all clinical settings and laboratories that process specimens for cervical cancer screening. Is Adding IgM Antibody to Polymerase Chain Reaction Testing Useful for COVID-19 Travel Screening? , Kinney WK, Cheung LC, et al. July 30, 2020-- The American Cancer Society (ACS) has made sweeping changes in its new cervical cancer screening guidelines published July 30, including a shift to primary HPV testing, with no cytology, as the preferred screening method. Cervical cytology remains the basis of the cervical screening approach with HPV testing limited to assisting with clinical management in specific circumstance. The overarching theme reflects a ‘risk-based’ strategy, rather than rigid focus on a particular result. The assumption of the article’s authors, that cervical cancer is the major clinical end point for the general screening population, seems surprising to us. As such, the prudent course of medical practice is to detect all CIN 3 lesions and to remove them before any can develop into invasive cervical cancer.   JC The expert advisory group, along with external stakeholder organizations (see Supporting Materials), served as external reviewers of the draft recommendation statements and the rationale before publication. Recently the American Cancer Society (ACS) updated its screening guidelines for cervical cancer to advocate a human papillomavirus (HPV) test every 5 years for women between the ages of 25 and 65 years. Cyto every 4 y from age 21 y/cotest every 5 y ages 25‐65 y, 6. Although the FDA approved the first test for primary HPV screening in 2014, as of 2017, only 40.6% percent of laboratories reported that they offered primary HPV screening, and, among those that did, primary HPV screening was a very small fraction of all HPV‐associated testing.134 Furthermore, the survey reported variability in the settings where HPV genotyping (for management of positive results, not primary HPV screening) was available. However, this characterization is not accurate. Data Source: North American Association of Central Cancer Registries Incidence Data‐Cancer in North America Analytic File. The 2012 joint guideline recommended against continued screening in women who had a history of adequate negative screening and no history of CIN2+ within the past 20 years.5 Adequate negative screening was defined as 3 consecutive negative cytology results or 2 consecutive negative cotests within the past 10 years, with the most recent test having taken place within the past 5 years.5 The rationale statement stressed that cervical cancer in the United States was most commonly diagnosed in unscreened and under screened individuals, whereas, in individuals with a history of routine screening, the prevalence of CIN2+ was low, cervical cancer was rare, and it was improbable that incident HPV infections and newly diagnosed CIN3 after age 65 years would progress to an invasive cancer in an individual's lifetime. Evidence supporting the usefulness of HPV self‐sampling includes substantial increased participation of hard‐to‐reach women in home‐based screening programs. . As such, the reader does not know if the data should have been pooled and analyzed together (as was the case in the article) or if the data sets should have been analyzed separately—one for the FDA-approved testing methods and the other for the off-label testing methods. Cyto every 4 y from age 21 y/HPV every 3 y ages 25‐65 y, 4. The data used by Kaufman et al1 raises several questions that are difficult to resolve based on the information provided. 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. National cervical cancer screening guidelines shift to primary HPV testing By Emily Hayes, editor in chief. Two screening tests can help prevent cervical cancer or find it early— The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. Breast, Cervical, CRC Screening Below Healthy People 2020 Targets Colorectal cancer test receipt near target in 2018, with 66.9 percent of adults aged 50 to 75 years up to date with testing .   ETH Another important question for continued research concerns the effectiveness of screening tests in a vaccinated population as the uptake of HPV vaccination increases, including the incorporation of new genotyping tests and opportunities to extend screening intervals. 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.,,,,,,,,, I have read and accept the Wiley Online Library Terms and Conditions of Use, Trends in cervical cancer incidence rates by age, race/ethnicity, histological subtype, and stage at diagnosis in the United States. In June 2020 New Zealand released updated cervical screening guidelines. Kaufmann et al1 seek “to reconcile the contrasting conclusions derived from the regional KPNC [Kaiser Permanente Northern California] population, suggesting that HPV primary testing is more effective than cotesting for diagnosing cervical cancer, and the national Quest Diagnostics population findings, which suggest the opposite” and suggest that their data are more representative of the US population as a whole. It doesn’t take time out; nor does it give us a break. ©2020 Mayo Foundation for Medical Education and Research Distributed by Tribune Content Agency, LLC. We do not discount the contributions from identifying and treating precancerous lesions in reducing morbidity and mortality from cervical cancer. On the basis of the consistent low cervical cancer incidence and mortality among women aged <25 years, the high incidence of transient infections, the risk of adverse obstetric outcomes of treatment, and the decision analysis demonstrating a favorable benefit‐to‐harm balance for beginning screening at age 25 years, cervical cancer screening is strongly recommended from age 25 years with primary HPV testing (preferred) or, as the United States makes the transition to primary HPV testing, with the previously recommended screening strategies of cotesting every 5 years or cytology alone every 3 years (acceptable). The higher risk of cervical cancer in individuals who are immunosuppressed because of HIV infection is well established in the literature.123 For these individuals, the recommendations for screening from the Centers for Disease Control and Prevention, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America,124, 125 and the US Department of Health and Human Services126 should be followed. In the past, cervical cancer was one of the most common causes of cancer death for American women, but increased use of the regular screening tests has significantly improved survival rates. The ACS 2012 recommendation for cotesting as the preferred test was limited to women aged ≥30 years. However, some of these testing methods not approved by the US Food and Drug Administration (FDA; ie, the FDA has not approved the use of HC2 or Aptima with SurePath LBC specimens in cervical cancer screening). Start here to find evidence-based information on cervical cancer treatment, causes and prevention, screening, research, and statistics. ; The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.Both tests can be done in a doctor’s office or clinic. Cervical Cancer Prevention & Screening Pathway Map HPV Vaccination Version 2020.01 Page 3 of 5 The pathway map is intended to be used for informational purposes only. 2020 Jul 30. doi: 10.3322/caac.21628. Continued accumulation of data over several rounds of HPV primary screening will provide greater confidence in the performance of primary HPV testing at the recommended screening interval. Invasive cervical cancer and screening: what are the rates of unscreened and underscreened women in the modern era? The panel indicated that the test showed effectiveness equivalent or superior to that of the current cytology‐based cervical cancer screening methods and thus concluded that HPV testing for cervical cancer screening starting at age 25 years can be considered as an alternative. 1 The new guideline raises the minimum screening age, and it represents a shift away from cotesting that combines the HPV with a Papanicolaou (Pap) test. This document outlines the role of Registered Nurses in Cervical Cancer Screening. If primary HPV testing is not available, individuals aged 25‐65 y should be screened with cotesting (HPV testing in combination with cytology) every 5 y or cytology alone every 3 y (acceptable) (, The ACS recommends that individuals with a cervix who are older than age 65 y, who have no history of cervical intraepithelial neoplasia grade 2 or a more severe diagnosis within the past 25 y, and who have documented adequate negative prior screening in the 10‐y period before age 65 y discontinue cervical cancer screening with any modality (, Cytology alone every 3 y starting at age 21 y, Starting at age 25 y, primary HPV test alone every 5 y (preferred), Aged 30‐65 y, switch to cotesting (preferred), cytology alone every 3 y (acceptable), Cotesting every 5 y or cytology alone every 3 y are acceptable options, For management of positive results and subsequent surveillance, refer to ASCCP 2020 Risk‐Based Management Consensus Guideline (Perkins, 2020, Discontinue screening if adequate negative prior screening, No screening after adequate negative prior screening, Individuals aged >65 y without documentation of prior screening should continue screening until criteria for cessation are met, Individuals without a cervix and without a history of CIN2 or a more severe diagnosis in the past 25 y or cervical cancer ever should not be screened, No screening after hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and no history of cervical cancer or serious precancer, Follow age‐specific screening recommendations (same as unvaccinated individuals), Follow age‐specific screening recommendations, Cytology (also known as Pap test or Pap smear), Examination of the cells in a sample taken from the cervix under a microscope to check for the presence of abnormal cells (abnormal cells may be precancerous or cancerous cells), A test to detect the DNA of oncogenic (high‐risk) types of HPV in a sample taken from the cervix, HPV is the causal agents of almost all cervical cancers, HPV types 16, 18, 45, 31, 51, 52, 33+58, 35+39+68, 56+59+66, Cotest (cytology and HPV test administered together), A test that combines cytology to look at cells under a microscope and test for HPV DNA in the same sample taken from the cervix, HPV types 16, 18, 45, 31, 51, 52, 33+58, 35+39+68, and 56+59+66, 2. Discuss follow‐up care for BC3NP clients according to the 2019 ASCCP Cervical Risk‐Based Management Guidelines 2. The principal recognized harms of cervical cancer screening include (most importantly) potential treatment‐related adverse obstetric outcomes (especially preterm birth)50; the diagnosis of, and corresponding clinical actions triggered by, CIN that would have regressed without treatment11; physical discomfort associated with testing and clinical procedures (ie, colposcopy, biopsy, and treatment)51; and the anxiety precipitated by false‐positive findings.52 Despite its limitations, the number of colposcopies is consistently used as the primary surrogate measure of harm because colposcopies commonly are prerequisite to more invasive treatments with greater short‐term and long‐term risks of harms, and the number of individuals undergoing colposcopy usually is reported in controlled studies.5, 45, Although cervical cancer screening with an annual Pap test has not been a recommended strategy for many years, adherence to longer intervals associated with currently recommended screening strategies has been uneven, in part because of established patterns of practice that prioritize continuity of regular care and perceived reluctance among individuals being screened to deviate from a test conducted more frequently that intuitively would appear to provide greater protection.53 Screening more frequently than recommended will increase unnecessary burden and exposure to the risk of harms. However, given the wide screening interval, the accumulation of serial testing data with longer versus shorter screening intervals will require a lengthy observation period. Download PDF. Primary HPV cervical cancer screening in the United States: are we ready? Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Access the full text of current ACS screening recommendations (and rationale) for prevention and early detection of cervical cancer. Cervical screening samples are tested for types of HPV that can cause cervical cancer. The first invitation is sent to eligible people at the age of 24.5 years. The guidelines are found at: Guideline: Recommendations are presented for screening asymptomatic women who are or have been sexually active. New Management Guidelines Are Here. The point of cervical cancer screening is to detect and treat precancer in order to prevent the development of cervical cancer. The combination of cytology and HPV testing (cotesting) offers very little incremental benefit in detection but increases the number of procedures and the risk for harms. ASCCP released new guidance (April 2020) to inform assessment and treatment of abnormal cervical cancer screening results.   HW But over the past decade, rates have been declining. We look forward to ongoing discussion of this topic as we continue to advance the impact of cervical cancer screening programs. Most private health plans cover these services without copays or deductibles. American Cancer Society Recommendations for Cervical Cancer Screening, 2020 The recommendations apply to all asymptomatic individuals with a cervix, regardless of their sexual history or human papillomavirus (HPV) vaccination status, including those who have undergone supracervical hysterectomy and transgender men who retain their cervix. 2020;24:102-131. Joint guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (ACS/ASCCP/ASCP) define adequate prior screening as 3 consecutive negative cytology results or 2 consecutive negative cotesting results within 10 years before stopping screening, with the most recent test occurring within 5 years. In this update of the ACS guideline for cervical cancer screening, we recommend that cervical cancer screening should begin in average‐risk individuals with a cervix at age 25 years and cease at age 65 years and that the preferred strategy for regular screening is primary HPV testing every 5 years (Table 1). New guidelines for the screening and treatment of cervical cancer. It is unfortunate that the data did not include the use of HPV assays that are FDA approved with SurePath LBC—namely, Roche cobas and BD Onclarity—which would have avoided the issue of on-label vs off-label use of HPV testing. Evidence Synthesis, No.   M The ACS recommends that cervical cancer screening … They do not apply to women with symptoms of cervical cancer, previous abnormal screening results (until they have been cleared to resume normal screening), those who do not have a cervix (due to hysterectomy), or who are immunosuppressed. Please see the Australian Department of Health Cancer Screening website for information about the National Cervical Screening Program (NCSP National Cervical Screening Program A joint program of the Australian, state and territory governments. Abbreviations CIN, cervical intraepithelial neoplasia; COLPOS, colposcopies; Cotest, cytology and human papillomavirus test; Cyto, cytology; HPV, human papillomavirus test; LYG, life‐years gained. Distribution of Cervical Cancer Cases by Age at Diagnosis, United States, 2012 to 2016. ACCSP Cervical Cancer Screening Provided by Registered Nurses Guideline *UPDATED July 7, 2020. This document guides RNs through the cervical cancer screening process. These guidelines aim to personalize screening and management, reducing unnecessary testing in low-risk patients and managing high-risk patients with more intensive follow-up. Recent guidelines have recommended the use of HPV‐based testing for cervical cancer screening, either with cotesting beginning at age 30 years5, 15 or with stand‐alone primary HPV testing beginning either at age 25 years16 or at age 30 years.15 There is clear evidence of superior sensitivity of HPV‐based testing compared with cytology across all age groups.3, In the RCTs of the effectiveness of primary HPV testing, women were eligible to start screening at age 25 years. Most private health plans cover these services without copays or deductibles. Although screening tests are not expected to perform differently in these individuals, this limitation in the data is acknowledged. As noted above, the aim of the systematic evidence review that served as the principal source of empirical evidence for this guideline update was to evaluate the benefits and harms of cervical cancer screening using primary HPV testing and cotesting.3, 4 The GDG prioritized a reduction in cervical cancer incidence through the identification and treatment of advanced cervical precursor abnormalities, in addition to mortality reduction, as the primary beneficial outcomes of screening. 168 summary: cervical cancer screening and prevention, Screening‐preventable cervical cancer risks: evidence from a nationwide audit in Sweden, Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme, Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population‐based study in routine clinical practice, Clinical practice guidelines in practice and education, Cervical screening at age 50‐64 years and the risk of cervical cancer at age 65 years and older: population‐based case control study, Effectiveness of cervical screening after age 60 years according to screening history: nationwide cohort study in Sweden, Efficacy of screening in preventing cervical cancer among older women, Case‐control study of cervical cancer and gynecologic screening: a SEER‐Medicare analysis, Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting, Age at last screening and remaining lifetime risk of cervical cancer in older, unvaccinated, HPV‐negative women: a modelling study. Release of the 2020 American Cancer Society Cervical Cancer Screening Guidelines On July 30th, the American Cancer Society (ACS) released its updated guidelines for “Cervical Cancer Screening for Individuals at Average Risk". If you do not receive an email within 10 minutes, your email address may not be registered, By endorsing primary HPV screening once every 5 years, some women will escape cervical cancer detection who would otherwise have been detected using the cotesting approach. If patients with a history of CIN2, CIN3, or AIS have completed the initial 25‐year surveillance period when they reach age 65 years, continued surveillance at 3‐year intervals is acceptable and may continue as long as the patient is in reasonably good health. Cancer screening—has inferior sensitivity and provides lesser assurance regarding future risk professionals and target. Or CIN3+ risk measures reliable surrogates for invasive cervical cancer screening begin at age 21 y/cotest every 5 ages... 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