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

Abstract

An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical precancerous lesions and cancer is presented. The guidelines are based on a systematic evidence review, contributions from 6 working groups, and a recent symposium cosponsored by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, which was attended by 25 organizations. The new screening recommendations address age‐appropriate screening strategies, including the use of cytology and high‐risk human papillomavirus (HPV) testing, follow‐up (eg, the management of screen positives and screening intervals for screen negatives) of women after screening, the age at which to exit screening, future considerations regarding HPV testing alone as a primary screening approach, and screening strategies for women vaccinated against HPV16 and HPV18 infections. CA Cancer J Clin 2012. © 2012 American Cancer Society.

Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women Above Age 30 Years

“…[38][39][40][41][42][43][44] Although Co-testing is preferred over Primary Cytology by some guidelines, 5 this recommendation has been questioned. 12 Our analysis supports a Primary HPV strategy over Primary Cytology, because it detected more cases of CIN3+ at lower cost.…”

“…The first two, Primary Cytology and Co-testing, reflect current recommendations for women age 30 and older. 5,9,10,13 In the third strategy, Patients remaining HPV positive or ≥ ASCUS at 1 year are referred to colposcopy. Referred patients who do not undergo colposcopy do not incur colposcopy costs and cannot have CIN3+ detected, even if present.…”

“…4 Elucidation of the role of high-risk human papillomavirus (HPV) in cervical cancer pathogenesis has led to incorporation of HPV testing into primary screening strategies for women age 30 and older. 5 When cytology and HPV tests are used together (co-testing), sensitivity approaches 100 %, 6 and the 5-year risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) after a negative co-test is far below that with negative cytology alone, supporting longer testing intervals. 7,8 For this age group, multiple organizations now recommend co-testing every 5 years as an alternative to cytology.…”

“…7,8 For this age group, multiple organizations now recommend co-testing every 5 years as an alternative to cytology. 5,[9][10][11] The American Cancer Society, The American Society of Colposcopy and Cervical Pathology (ASCCP) and the American Society of Clinical Pathology recommend co-testing as a Bpreferredŝ creening strategy, 5 although the appropriateness of this recommendation has been questioned. 12 The US Preventive Service Task Force (USPSTF) recommends cytology or cotesting as acceptable screening.…”

Attend to the “Small p” Stuff: State Policy Issues Affecting Cervical Cancer Efforts

“…Prophylactic vaccines against human papillomavirus (HPV) infection are safe and effective [1]- [3]. Diagnostic and screening tools for HPV detection are now available and have been recommended for women > 30 years [4] [5], and there are treatment options for early stages of cervical precancer or invasive disease. The keys to the success are HPV vaccination, early identification and treatment of pre-cancerous disease.…”