Standalone HPV Testing Recommended for Cervical Cancer Screening

The number of deaths from cervical cancer in the USA has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100,000 women from 2000 to 2015.

The evidence on screening for cervical cancer has been reviewed with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (co-testing) compared with cervical cytology alone.

The US Preventive Services Task Force (Rockville, MD, USA) besides reviewing and evaluating cervical cancer screening also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

The experts reported on screening with cervical cytology alone, primary hrHPV testing alone, or co-testing can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. Four studies identified in the review found that primary hrHPV testing detected higher rates of stage 3 (or worse) cervical intraepithelial neoplasia compared with the standalone Pap test in the first round of testing. In comparing the Pap, hrHPV and co-testing methods, the latter two methods were associated with higher colposcopy and false-positive rates.

The scientists concluded with high certainty that the benefits of screening every three years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. They also concluded with high certainty that the benefits of screening every three years with cytology alone, every five years with hrHPV testing alone, or every five years with both tests (co-testing) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. The anticipation is hrHPV testing every five years for women aged 30 to 65 could reduce cervical cancer mortality from 8.34 to 0.29 deaths per 1,000 women.

Lee A. Learman, MD, PhD, professor of obstetrics and gynecology, said, “HPV testing every five years is an attractive option for patients who want to avoid pelvic exams and Pap smears. The Pap test is well known and accepted by patients and women’s healthcare providers, and there would need to be powerful incentives to move away from it. Switching from Pap tests annually to every three years has been the USPSTF recommendation since 2012, but patient and provider preferences have been hard to change. I expect the same phenomenon will delay implementation of primary HPV screening every 5 years.” The study was published on August 21, 2018, in the Journal of the American Medical Association.

Related Links:
US Preventive Services Task Force