Increased Cervical Cancer Risk Associated With Screening at Longer Intervals

Abstract

The 2012 national recommendations for cervical cancer screening will produce a lower level of cervical cancer protection than previously afforded by annual cytology or 3-year cotesting. After a single negative cotest result, the risk of cervical cancer is twice as large at 5 years as it is at 3 years. Modeling published since the 2012 guidelines were drafted indicates that extending the cotesting screening interval from 3 to 5 years at ages 30-64 years will result in an additional 1 woman in 369 compliant with screening receiving a cervical cancer diagnosis during her lifetime, and an additional 1 in 1,639 dying of cervical cancer. The authors believe that a significant number of patients and providers would not choose to accept these additional risks if they understood them, despite the recognition of potential harms associated with more intensive screening.

Increased cervical cancer risk associated with extended screening intervals after negative human papillomavirus test results: Bayesian risk estimates using the Pittsburgh Cervical Cancer Screening Model

“…6 We agree with this important observation, as CIN3 and CIN3þ have largely been substituted as surrogate endpoints for cervical cancer risk in cervical screening trials in which low numbers of cervical cancers otherwise result in a lack of statistical power for making conclusions about cervical cancer risk. As noted by the US Preventive Services Task Force, "the degree of benefit in preventing invasive cancer cannot be determined from test performance studies alone.…”

“…6 Available studies comparing these options consistently document a relative increased cervical cancer risk with every 3-year versus annual screening in the range of 1.3 to 4.7 years. [6][7][8][9][10][11][12] Even as increased cervical cancer risks were discounted by guideline developers, there was increased emphasis on prevention of testing-associated "harms" and reliance on surrogate endpoints for cervical cancer risk, such as cervical intraepithelial neoplasia 3 (CIN3) or CIN3 or more severe lesions (CIN3þ). Benchmarking of CIN3þ risk, based almost exclusively on data from Kaiser Permanente Northern California (KPNC), substantially drove the influential American Cancer Society/ American Society for Colposcopy and Cervical Pathology/ American Society for Clinical Pathology guidelines process.…”

“…13 More recently, however, has it been acknowledged by several of the 2012 guidelines authors themselves that the surrogate endpoint of CIN3þ may be misleading as an outcome measure for population screening. 6 Accordingly, some of them have recently explicitly called for additional "data sources that permit examination of cervical cancer risks over time rather than surrogate endpoints." 6 In response to this call, we decided to use the large accumulated cervical screening database at Magee-Womens Hospital (MWH) of University of Pittsburgh Medical Center (UPMC), our proprietary Pittsburgh Cervical Cancer Screening Model (PCCSM), 14 a continuously updated dynamic Bayesian decision science tool, to further explore the impact of extended cervical screening intervals on invasive cervical cancer risk.…”

Transitioning to a new era in cervical cancer screening

“…Is the very slight decrease in cancer affordable, considering many competing health priorities? [19].…”

Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening in the United States: Is It Time?

“…Authors who express these concerns believe that the risk level that different individuals would prefer should be a personal choice, and patients and physicians should be offered a ''range of acceptable screening options.'' 22,23 While this argument was published before the interim guidance for primary HPV screening, the concept is still relevant.…”