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Cervical cancer screening guidelines

January 9, 2014

AmeriHealth is working to reduce the incidence and mortality rates of cervical cancer by promoting regular cervical cancer screenings. Through our Cervical Cancer Screening Program, reminders are sent to our female members to encourage them to schedule their regular Pap tests and Humanpapillomavirus (HPV) tests, as appropriate. We encourage you to discuss screening recommendations, lifestyle risk factors, prevention, early detection, and treatment options with your patients. According to the American Cancer Society, incidence of cervical cancer and associated mortality rates have decreased significantly in the past decades, with most of the reduction attributed to widespread use of Pap tests.1 The reduction in mortality through screening is due to: an increase in the detection of invasive cancer at early stages, when the five-year survival rate is approximately 92 percent;2 the detection and treatment of pre-invasive lesions, which reduces the overall incidence of invasive cancer. Since the introduction of cervical cytology in the United States in the middle of the 20th century, cervical cancer, once the most frequent causes of cancer death in women, now ranks 14th for cancer deaths.3 The new screening guidelines from the American Cancer Society, American College of Obstetrics and Gynecology, and other nationally recognized medical organizations address appropriate ages for screening, medical conditions that affect screening, such as hysterectomy, appropriate screening intervals, and additional screening technologies, such as HPV with DNA co-testing. The following are the screening recommendations: Ages 21?29: Cytology alone is recommended every three years. HPV testing is not recommended for screening in this age group. Ages 30?65: HPV with cytology every five years is the preferred method for screening; cytology alone every three years is an acceptable alternative. Recommendations state that women should have three consecutive negative Pap tests before expanding to screening every five years. Ages 65 and older: No further screening with adequate screening history is recommended. HPV-vaccinated women: Follow the same age-specific recommendations as for unvaccinated women.4 Additional screening recommendations are listed for women who have had a diagnosis of cervical intraepithelial neoplasia (CIN2 or CIN3) with or without hysterectomy, or who have a higher risk for cervical cancer (immunocompromised, family history, HPV or chlamydia infections, exposure to DES [Diethylstilbestrol]). For more information on screening and risk factors, visit the American Cancer Society website.

References

1 Statistics, 2004. CA: A Cancer Journal for Clinicians. VOL.54/NO.1 January/February 2004.

2-3 American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. 2012. CA: A Cancer Journal for Clinicians. DOI: 10.3322/ caac.21139. http://onlinelibrary.wiley.com/doi/10.3322/caac.21139/full.

4 Centers for Disease Control and Prevention (CDC) Cervical Cancer Guidelines for the Average-Risk Woman: www.cdc.gov/cancer/ cervical/pdf/guidelines.pdf.


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