Women over 30 may need to get a pap smear only once every five years if they undergo testing for the human papillomavirus (HPV) at the same time, according to new cervical cancer screening guidelines.
The guidelines, announced today (March 14) by the U.S. Preventative Task Force, say women between ages 30 and 65 who receive a normal pap test result and negative HPV test can safely wait five years to have their next screening.
An early draft of the guidelines was released in October. At that time, the task force said there was not enough information to judge the risks and benefits of HPV testing. But since then, new information has become available, including a Dutch study published in December that suggested that, for women over 30 with a normal pap test and negative HPV test, the risk of cervical cancer within the next three to five years is very low.
“It's really about time,” Dr. Leo Twiggs, a professor of obstetrics and gynecology at the University of Miami School of Medicine, said of the inclusion of HPV testing in the new recommendations. “This is a more precise way of determining whether the disease is really there or not,” Twiggs said.
The task force does not recommend HPV testing for women under 30, as HPV infection is common in this group and is often cleared by the immune system.
Other recommendations in the new guidelines are consistent with what the U.S. Preventative Task Force has said previously: women should start cervical cancer screening at age 21, and undergo screening every three years until age 65 (unless they choose to lengthen their screening interval by also getting an HPV test after age 30). This recommendation applies to women regardless of their sexual history.
The task force does not recommend cervical cancer screening for women under 21, as cervical cancer is rare in this group and evidence suggests screening does more harm than good. Abnormal results from a pap smear in women and teens under 21 are likely to be due to a temporary condition, the guidelines say.
Women over 65 do not need to be screened for cervical cancer if they have received adequate screening in the past and are not at increased risk for the disease, the guidelines say. And women who've had a hysterectomy, including removal of the cervix, and who do not have a history of cervical cancer or precancerous lesions do not need to be screened.
Screening for cervical cancer screening comes with risks of additional testing and treatments for precancerous lesions that may go away on their own. Some treatments of cervical cancer are associated with a risk of harmful outcomes in pregnancy, such as preterm delivery, the guidelines say.
A positive HPV test is considered a positive screening result, said study research, Dr. Virginia Moyer, professor of pediatrics at Baylor Medical College in Houston and chairwoman of the task force for cervical cancer screening. For this reason, women who chose HPV testing in addition to pap testing should be aware that they may require additional, more frequent tests if their HPV test is positive, Moyer said. About 11 percent of women ages 30 to 34 who have a normal pap test will have a positive HPV test, the guidelines say.
The new recommendations do not specify that screening be done differently for women who've received the HPV vaccine.
“Future evidence may show that less frequent screening will be appropriate in vaccinated women, but given the limitations of current research, and the low vaccination coverage among unexposed U.S. adolescents,” screening recommendations for vaccinated women should not differ from those for unvaccinated women at this time, Dr. Nora Kizer and Dr. Jeffrey Peipert of the Washington University in St. Louis School of Medicine, wrote in an editorial accompanying the guidelines.
The guidelines and editorial are published today (March 14) in the journal Annals of Internal Medicine.
Pass it on: Women over 30 who are screened for cervical cancer with HPV testing and a pap smear may not need another screening for five years.
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