CA Cancer J Clin: Simplify cervical cancer screening, with changes in starting age and screening methods.

Recently, the American Cancer Society (ACS) issued the latest cervical cancer screening guidelines.
the guidelines suggest, screening measures will be simplified.
important update is that it is recommended that women aged 25-65 first screen for cervical cancer every 5 years with a human papillomavirus (HPV) test.
if primary HPV tests are not possible, a cytology (commonly known as pasteur smear) examination can be performed every 3 years, or a combined cytological and HPV examination every 5 years.
In this means that the new ACS guidelines are the first to use primary HPV screening alone, knowing that cytology screening has always been the gold standard for cervical cancer screening, and that the starting screening age is four years late compared to the current guidelines recommend starting screening at age 21.
These simplified screening recommendations can improve female compliance and reduce potential harm," said Dr. Debbie Saslow, director of HPV and gynecological cancer at the American Cancer Society.
Dr Saslow adds that there is now stronger evidence to support delayed screening and the preferred HPV test, after accumulating a large body of research comparing the effects of HPV and cytology tests.
that the newly recommended primary HPV test at age 25 could "prevent 13 percent more cervical cancer cases and 7 percent more deaths" than the current recommendation.
model shows that "this can be achieved by increasing follow-up by 9 per cent, but overall the number of inspections required has decreased by 45 per cent."
", the starting screening age has been delayed to 25, taking into account the increasing rate of HPV vaccination among young people.
team noted that "cytological examinations are much less efficient in vaccinated populations."
because vaccines can prevent high-risk HPV-type infections, most of the abnormal results of cytological examination are mild lesions caused by low-risk HPV-type.
as vaccination rates increase, the percentage of false positives will increase.
", ACS also recommends that doctors consider cervical cancer screening findings and vaccinations to accurately assess screening results.
, less than 1% of cervical cancers are diagnosed before the age of 25, and the rate will be even lower as vaccination rates increase.
, the false positive rate is much higher in young patients, and false positive results may have a negative impact on pregnancy outcomes.
Saslow also said the new recommendations would not affect the workload of health care workers because joint and primary HPV tests operate in a similar way.
In clearly, the latest recommendations are very different from the current ACS guidelines or 2 other agency guidelines: the current joint recommendation of the American Cancer Society (ACS), the American Society for Vaginal and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP) is that "cytological examinations every three years for women aged 21-65 can be changed from 30 to 5 years".
The American College of Obstetricians and Gynecologists (ACOG) currently recommends cytology tests every three years from age 21 and joint examination every five years from age 30.
The U.S. Preventive Services Task Force (USPSTF) began adjusting screening recommendations in 2018 to state that "cytology tests are performed every three years for women aged 21-65 years, and HPV tests or joint tests can be performed every five years from the age of 30."
is also the first time that USPSTF has recommended a separate HPV check.
the new ACS guidelines, the option of cytology screening is still retained because in some cases women may not be able to obtain HPV tests approved for primary screening.
transition to primary HPV screening, future guidelines will no longer recommend a separate cytological examination or a combined cytology test.
, the FDA has approved two first-line primary HPV tests for cervical cancer screening.
the difference between cytological examinations and HPV tests, which are significantly changing in status in the new guidelines, is that cytological examinations require the collection of cervical cells through cervical scrapers, which are then dyed and microscopeed.
that although cervical cancer screening has been the "golden standard" since its inception 75 years ago, cytological examinations can only detect about 50% of cervical precancerian lesions.
more accurate to check for HPV, which is the leading cause of cervical cancer.
hpV tests can only determine whether a woman is infected with cancer-causing HPV, not the actual risk of cancer, which can cause unnecessary worry for many women.
advantage of HPV screening, screening intervals are longer and less frequent.
, both ASCCP and ACG said they were conducting a more comprehensive review of the latest ACS recommendations to determine whether they needed to be followed up.
. Christopher M. Zahn, vice president of practice at ACOG, said the current screening recommendations "balance the benefits and potential harms of screening."
that the incidence of cervical cancer in the United States has halved in the past 30 years as a result of extensive screening, evidence-based cervical cancer screening methods will continue to drive a reduction in cervical cancer incidence.
recommendations of the "65-year-old" ACS guidelines include that all screening should be discontinued for women over the age of 65.
unless they have a history of precancerian lesions in the past 25 years (cervical epiderma lesions (CIN), level 2 or above), or lack adequate negative screening records."
A sufficient negative screening record is defined as: 2 consecutive primary HPV tests in the past 10 years were negative, or 2 negative joint tests or 3 cytological tests were negative, and the most recent examination was conducted in the last 5 years.
these standards do not apply to populations that currently need to continue to be monitored due to abnormal screening results.
if you do not have an adequate screening record, are over 65 years of age and have no effect on life expectancy, screening should continue until the criteria for stopping screening are met.
, cervical cancer screening can be interrupted if life expectancy is limited.
recommendations are similar to those of existing guidelines.
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