Pap Test or hrHPV Test, Choose One, Not Both

Cervical cancer deaths in the United States have decreased dramatically since the implementation of widespread cervical cancer screening and HPV vaccinations.

And the decline in cervical cancer continues today.

Most cases of cervical cancer occur in women who were not vaccinated with the papilloma virus (HPV) vaccine.

To ensure that women are appropriately screened, the U.S. Preventive Services Task Force (USPSTF) found convincing evidence that screening with cervical cytology or testing for high-risk HPV types (“hrHPV testing”) can detect high-grade precancerous cervical lesions and cervical cancer.

The major change in this draft recommendation compared with the 2012 standard it would replace is that co-testing is no longer recommended.

The USPSTF is recommending that primary care clinicians screen for cervical cancer in women 21 to 29 years of age, every three years with cervical cytology, more commonly known as the Pap test.

For women 30 to 65 years of age, the USPSTF recommends either screening with cervical cytology alone every three years or screening with hrHPV testing alone every five years.

"The Task Force looked at the evidence on the effectiveness of different screening tests and intervals based on age, and found that after age 30, the Pap test and hrHPV tests are both effective for cervical cancer screening," said Task Force member Maureen G. Phipps, MD.

Each cervical cancer test has pros and cons. Women should discuss with a healthcare provider which screening option is most appropriate for them.

"False-positive rates are higher among women younger than age 30 ... because of the higher incidence of transient HPV infection in younger women, even though cervical cancer incidence is lower in this age group," the Task Force wrote.

In addition, co-testing "increases the number of follow-up tests" by as much as twofold and does not lead to increased detection of CIN3+ (CIN3 and all invasive cancers), so "the USPSTF did not include co-testing in this recommendation statement."

These new recommendations do not apply to women:

• who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer,
• who had in utero exposure to diethylstilbestrol, or
• have a compromised immune system

The Gardasil 9 vaccine immunizes against nine genotypes of HPV known to cause cervical cancer, as well as vulvar, vaginal and anal cancers and genital warts caused by HPV.

This vaccine is an advance over the four-valent HPV vaccine, Gardasil, which was approved by the FDA in 2006.

The CDC Vaccine Price List provides the private sector vaccine prices for general information.

Most pharmacies offer vaccination services, including HPV. Vaccine discounts can be found here.

These draft USPSTF recommendations were published on the USPSTF Web site, where comments may be submitted. Public comment on this recommendation statement will be accepted until October 9, 2017.

Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: A Systematic Evidence Review for the U.S. Preventive Services Task Force