The U.S. Preventive Services Task Force has released new draft recommendations for cervical cancer screening that would allow women 30-65 to use a Pap smear alone every three years or to use an HPV test alone every five years to screen for the disease. The draft recommendations have been posted to the USPTF website for public comment, a practice the Task Force has followed with all its draft recommendations since 2013 “to further enhance its work,” according to the USPTF.
Providence Business News caught up with Dr. Maureen Phipps, chief of obstetrics and gynecology at Women & Infants Hospital of Rhode Island, to ask about the change and what it would mean for women’s health if the recommendations are adopted.
PBN: Can you explain the reasoning behind the new guidelines for women 30-65?
PHIPPS: The major change in this draft recommendation is that, beginning at age 30, women can choose to be screened with HPV testing alone every five years or with a Pap test alone every three years. Co-testing (using a combination of a Pap test and HPV testing) was a part of the 2012 recommendation, and is no longer a part of the Task Force’s current recommendation. This is due to updated research, which helped the Task Force determine that getting both tests at the same time did not offer women much additional benefit compared with getting either a Pap test alone or an hrHPV [high-risk human papillomavirus] test alone.
PBN: What about the uncertainty during the longer interim between tests? Wouldn’t a problem have more time to develop unchecked?
PHIPPS: As it does with all of its recommendation statements, the Task Force reviews the best available evidence on a preventive service. For cervical cancer, the evidence shows that screening with a Pap test every three years or hrHPV testing every five years provides the best balance of benefits to harms. Screening more frequently than every three years with a Pap test alone offers little additional benefit, with increases in harms, including additional procedures, assessment and treatment of transient lesions. Screening more frequently than every five years with hrHPV testing alone also doesn’t offer substantial benefits and increase the number of additional screening tests and colposcopies.
PBN: How will this change affect providers and patients?
PHIPPS: The most important thing is that women continue to be regularly screened. The Task Force recommendation is for women aged 21-29 should be screened every three years. Women aged 30-65 have a choice to be screened with a Pap test every three years or hrHPV testing every five years. The Task Force found that both Pap tests alone and HPV testing alone are effective ways to screen for cervical cancer in women aged 30-65, so women in this age group should discuss which testing strategy is best for them with their women’s health provider.
PBN: What effect will this have on insurers/payers?
PHIPPS: As a draft recommendation, this release will not affect insurance coverage. Regardless, it’s important to note that the Task Force does not make coverage decisions and encourages all patients who are concerned about their health to consult with their primary care provider. The Task Force’s sole role is to evaluate the evidence on the benefits and harms of a preventive service.
PBN: This change will align USPTF advice with other organizations – do you feel this will combat confusion for patients and providers about the best approach to prevention? How likely are the guidelines to change again?
PHIPPS: What’s most important is that women get screened regularly. The Task Force hopes the recommendation continues to promote screening for cervical cancer. For women ages 30-65, they can now choose to be screened with HPV testing alone every five years or with a Pap test alone every three years and should discuss with their primary care provider which method is right for them.
Regarding the likelihood of the recommendation to change, the Task Force will review and consider all comments it receives on the draft recommendation during the public comment period before finalizing the recommendation statement.
Rob Borkowski is a PBN staff writer. You an email him at Borkowski@pbn.com.
