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Posted at 12:07 PM ET, 10/19/2011

Groups issue conflicting proposals for cervical cancer screening recommendations

Leading medical groups Wednesday proposed new guidelines for how often and how women should undergo screening tests for cervical cancer.

The U.S. Preventive Services Task Force, the independent panel of federal advisers that last week stirred debate by questioning the use of PSA testing to screen for prostate cancer, is recommending women undergo Pap smears for cervical cancer only every three years beginning at age 21.

That recommendation agrees with a separate set of proposed new guidelines also released Wednesday by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology. Those groups had previously recommended that women under age 21 begin screening three years after starting to have sexual intercourse and that women ages 21 to 29 get the tests annually. Now they are recommending women 21 to 29 can get tested every three years.

In addition, the group is proposing that women age 30 and older also get tested every three years. Currently, the groups had said only women age 30 and older who had three normal Pap tests in a row could be tested less often than annually, every two to three years.

For older women, the proposed guidelines say women age 65 or older do not need to be screened if they have had three or more normal tests in a row and no abnormal results in the last 10 years, or had two or more negative tests for the human papilloma virus (HPV), which can cause cervical cancer, in the last 10 years. Current guidelines say women can stop being tested at age 70 when they have had three or more normal tests in a row and no abnormal tests in the last 10 years.

Those groups are also proposing recommending that for women age 30 and older, Pap tests be combined with HPV testing every three to five years. The current guidelines call the addition of HPV an “option.”

The proposal to recommend routine HPV testing is at odds with the U.S. Preventive Services Task Force’s proposed guidelines, which said a systematic review of scientific literature had concluded that the current evidence was insufficient to recommend HPV testing yet.

HPV testing “can lead to harms, and the harms of screening can take many forms. Abnormal test results can lead to more frequent testing and invasive diagnostic procedures, such as colposcopy and cervical biopsy,” the task force concluded.

“Evidence from randomized, controlled trials and observational studies indicate that harms from these diagnostic procedures include vaginal bleeding, pain, infection, and failure to diagnose (inadequate sampling). Abnormal screening test results are also associated with mild psychological harms; short-term increases in anxiety, distress, and concern about health have been reported with cytology and HPV testing,” the task force wrote.

All the medical groups are accepting public comment on the proposed revisions through next month before producing a final set of “consistent guidelines that will lead to less confusion for providers and the public,” according to a statement released by the cancer society and the two other groups.

The proposed changes come amid sometimes intense debate over how often screening should be done for many illnesses. The task force triggered intense controversy in 2009 when it raised questions about routine mammography for breast cancer for younger women. And last week’s questioning of routine PSA testing for prostate cancer is still being hotly debated.

By  |  12:07 PM ET, 10/19/2011

 
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