New medical guidelines from the U.S. Preventive Services Task Force say that women over 30 can safely wait five years between cervical cancer screenings. These latest recommendations suggest that women be screened every five years with either HPV testing alone or Pap HPV co-testing. They may also choose to screen with a Pap test every three years. The guidelines were published on Tuesday in the Journal of the American Medical Association. "A lot of women think that annual screening is the way to go, but we now know that that causes more harm than good. The main reason is that it leads to a lot of extra invasive procedures without increasing the numbers of cancers detected," Debbie Saslow, senior director for HPV-related and women's cancers at the American Cancer Society, said in a statement. Teen boys in the U.K. will be given HPV vaccine to protect from cancer-causing virus https://t.co/TH6IwPvY7A — Lisa Spear (@LisaNSpear) July 25, 2018 The new cervical cancer screening recommendations specify that women under age 30 should still get the Pap test every three years, starting at age 21. The guidelines say that screenings are no longer needed after age 65. "I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone," Saslow told NPR. There's some evidence the HPV test could more easily detect a less common form of cervical cancer, adenocarcinoma, she explained. "So wouldn't you rather find the two most common cancers instead of just the one most common type?" The Pap test tells a woman if she has any abnormal cervical cells on the day of the test. On the other hand, the HPV test can identify the virus that causes virtually all cervical cancer, even if the woman has no abnormal cells. Since the implementation of widespread cervical cancer screening, the number of deaths from cervical cancer in the U.S. have decreased and continue to fall, from 2.8 per 100,000 women in 2000 to 2.3 deaths per 100,000 women in 2015. "Most cases of cervical cancer occur among women who have not been adequately screened," the USPSTF said in its recommendations.<doc-sep>Story highlights Women ages 30 to 65 now have three choices in cervical cancer screening Women 21 to 30 should get Pap smears every three years Women under 21 and over 65 still don't necessarily need to screen (CNN) — Women over 30 years old have a new option when it comes to screening for cervical cancer, according to guidelines released Tuesday by the US Preventive Services Task Force and published in the journal JAMA. Because most cervical cancer is caused by the human papillomavirus, also known as HPV, women 30 to 65 can opt to get an HPV test every five years, a Pap test every three years or a combination of both tests every five years. In the past, the recommendations for women in that age group had suggested a Pap every three years and co-testing every five years. However, for women between 21 and 30, the previous recommendation of only a Pap smear every three years remains in place. That has been a guideline since the introduction of the Pap, also called exfoliative cytology, 75 years ago. In 2012, the task force – an independent panel of experts that makes recommendations to the American public about preventive services – set guidelines for other ages. Women under 21 normally should not be tested. Because cervical cancer is a slowly progressive disease and doesn’t show signs until it is advanced, testing at that age will show only evidence of human papillomavirus infections. Women over 65 who have had recent negative tests also can forgo testing if they wish. However, Pap and HPV tests do not check for early signs of other cancers or sexually transmitted diseases, specialists warn, so women should continue to visit their health care practitioners on a regular basis. Some strains of HPV cause cell changes on a woman’s cervix, which can lead to cervical cancer over 10 to 15 years, according to the US Centers for Disease Control and Prevention. Other strains cause genital warts, but those are very different from the ones that cause cancer. Worldwide, cervical cancer is the fourth most common cancer in women. Women with advanced cervical cancer may have abnormal bleeding, unusual vaginal discharge or pain. It strikes women in low-resource countries hardest, as they have limited access to medical care and therefore less screening and prevention. Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. Although the US has seen dramatic declines in cases of cervical cancer over the past 50 years, 13,240 new cases of cervical cancer and 4,170 cervical cancer deaths “are projected to occur” this year, Florida Atlantic University’s Dr. Lee Learman and the University of Arizona’s Dr. Francisco Garcia wrote in an editorial published alongside the new guidelines in JAMA. The vast majority of those deaths will be “among poor women, women from communities of color, non-US-born women, and women living in rural and remote settings,” who also have little access to preventive care, Learman and Garcia wrote. The recent introduction of an HPV vaccination protocol for adolescents has made eliminating cervical cancer a possibility, the doctors said, but parental adoption of the vaccine has not been as high as hoped.<doc-sep>Change is coming to guidelines for cervical cancer screening, which means women have some new options on this important test.Here are some of the guidelines:- Women 21-years-old to 29-years-old should still get a pap test every three years.- Women 30-years-old to 65-years-old can get an HPV test every five years or a pap test every three, or a combination every five years.The new guidelines give women more options and all are reliable.They're based on solid evidence showing that almost all cases of cervical cancer are caused by HPV, or the human papilloma virus and the HPV test is the best way to detect that the virus is causing damage.That's for women older than 30. For women under 30, the pap test is recommended.------<doc-sep>Some women have a new option for cervical cancer screening — and it doesn't necessarily involve a Pap test — according to updated guidelines from a government-appointed panel of experts. The guidelines, from the U.S. Preventive Services Task Force (USPSTF), say that women ages 30 to 65 can be screened for cervical cancer with a test for "high risk" strains of the human papillomavirus (HPV) every five years, without undergoing a simultaneous Pap test. Previously, the USPSTF recommended "co-testing" — or the use of both the HPV test and the Pap test — every five years, for women ages 30 to 65. While "co-testing" is still one recommended way to screen for cervical cancer, it is a less preferable method, because its use may result in women undergoing more tests and procedures overall, compared with either HPV testing or Pap testing alone, the new guidelines say. [5 Cervical Cancer Facts] Alternatively, women ages 30 to 65 can be screened for cervical cancer with the Pap test alone every three years, according to the guidelines. Although some women now have more choices for cervical cancer screening, the most important thing is for them to get screened: Efforts to carry out the guidelines should "focus on ensuring that women receive adequate screening, regardless of which strategy is used," the USPSTF said. "Regular screening with any method will lead to lower cervical cancer rates," Dr. Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research, said in a statement. "Our biggest challenge is reaching women who have not been screened," added Melnikow, who led one of the studies on HPV testing that informed the new guidelines. High-risk strains of HPV are spread through sexual contact and cause about 90 percent of cervical cancers. Although most HPV infections clear up on their own, in some cases, the virus lingers and may eventually lead to cervical cancer. Both the HPV test and the Pap test look at cells from a woman's cervix, according to the National Cancer Institute. In a Pap test, the cells are analyzed to see if they are cancerous, while in an HPV test, the cells are tested for HPV infection. (Co-testing can be done with just one cervical swab.) The guidelines, which are published today (Aug. 21) in the journal JAMA, are an update to the USPSTF's previous recommendations on cervical cancer screening, which were issued in 2012. A draft of the new guidelines was released in September 2017, and they have now been finalized. Here are some important things to know about the updated guidelines: What are the cervical cancer screening guidelines now? For women under age 30 and over age 65, the USPSTF's guidelines haven't changed. They are as follows: Women under age 21 should not be screened for cervical cancer. Women ages 21 to 29 should undergo screening every three years using a Pap test, also called "cervical cytology." (HPV testing isn't recommended for women ages 21 to 29 because, in this age group, HPV infection is common and is often cleared by the immune system.) Women over age 65 do not need to be screened for cervical cancer if they are up to date on their screening, their tests in the previous 10 years were negative and they don't have other risk factors for cervical cancer. For women ages 30 to 65, there are three options: a test for "high risk" strains of HPV every five years, a Pap test every three years, or co-testing with both the HPV and Pap test every five years. Women in this age group should speak with their doctor about which testing method is best for them, the guidelines say. The guidelines do not apply to women who have symptoms of cervical cancer, regardless of their sexual history, the USPSTF says. Nor do they apply to women who have previously been diagnosed with cervical cancer or with a high-grade precancerous lesion, or to women who have a condition that weakens their immune system, such as HIV. How are the guidelines different from before? Although HPV tests have been used for years to help screen for cervical cancer, it's the first time that national guidelines have recommended the sole use of HPV tests for women ages 30 to 65. The draft guidelines released in September 2017 originally did not include co-testing as a recommended screening method. However, some doctors expressed concern about the need for a transition period before HPV-only testing is adopted as a screening method for women ages 30 to 65, according to an editorial accompanying the study. In the final recommendations, co-testing was added back as a recommended method. The updated guidelines are based on the findings of recent studies, including one by Melnikow and colleagues, that found that testing for high-risk strains of HPV detected a higher rate of precancerous lesions in the cervix, compared with Pap tests. "Our work demonstrated that there is now strong evidence for the effectiveness of high-risk HPV testing used alone as a cervical cancer screening test," Melnikow said. Both HPV testing alone and co-testing were also slightly more effective at reducing deaths from cervical cancer than Pap testing alone, according to a separate study, also published today in JAMA. That study, which used a model to simulate the effectiveness of different screening strategies over women's lifetimes, found that, without screening, about 830 in 100,000 women would die from cervical cancer in a given population. But if women were screened with HPV testing every five years beginning at age 30, the rate of death dropped to 29 per 100,000 women. If women were screened with co-testing beginning at age 30, the rate of death was similar — about 30 deaths per 100,000 women. And if women were screened with the Pap test alone, the rate of death was higher — about 76 deaths per 100,000 women. Are there downsides to using the HPV test?<doc-sep>
(Reuters Health) - Not all women need Pap tests to look for cells in the cervix that might be malignant. Under new guidelines from U.S. physicians, some women can get a test that looks for the cancer-causing human papilloma virus (HPV). In both tests, doctors must scrape cells from the cervix for analysis. But the advice from the U.S. Preventive Services Task Force (USPSTF) is designed to reduce “false alarms” that lead to invasive follow-up tests and unnecessary treatment. The new guidelines also recognize that risks and benefits of cervical cancer screening change as women age. Women under 21 shouldn’t get screened at all, the Task Force says. In young women, HPV infection usually clears up on its own and is unlikely to cause cancer. From 21 to 29, women should get screened every three years with a Pap test, which detects abnormal cells but cannot detect HPV. Older women have a choice: from age 30 to 65 they can get Pap tests every three years. Or, they can get screened every five years with a test that looks for the high-risk types of HPV that cause cervical cancer. Or they can opt for “co-testing” every five years with both tests. “Screening more frequently than every five years does not substantially improve the benefits for women - it simply increases the number of screening tests and follow-up procedures women receive,” said Dr. Carol Mangione of the David Gaffe School of Medicine at the University of California Los Angeles. “A 5-year screening interval for HPV testing alone or co-testing offers the best balance of benefits and harms,” Mangione, a Task Force member, said by email. Doctors used to recommend annual Pap tests. But studies show that less frequent screening can still catch cancer early and that HPV testing needn’t be done at the same time as a Pap test, said Dr. Joy Melnikow, of the University of California, Davis, by email. Melnikow coauthored an evidence review for the USPSTF. Because HPV tests only detect the virus in the cervix, and not precancerous or cancerous cells, a positive test must be followed with a Pap or other tests. The chief advantage of HPV testing is less frequent pelvic exams, said Dr. Lee Learman, author of an editorial published with the new guideline in JAMA. Over time, as more people get a relatively new vaccine to prevent HPV, women may need cervical cancer screening even less often, Learman, of Florida Atlantic University in Boca Raton, said by email. In the meantime, the new guidelines may help reduce the number of tests that are positive for abnormal cells or HPV in women who don’t actually have cancer, said Dr. George Sawaya of the University of California, San Francisco, author of a second editorial. “While harms of screening are unavoidable, they can be minimized by screening less frequently and by using tests with fewer false alarms,” Sawaya said by email. “We don’t want to turn a lot of well women into patients.” SOURCE: bit.ly/2KoetVH JAMA, online August 21, 2018.