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New cervical cancer screening guidelines released: What you need to know

Cervical cancer screenings to start later and occur less often as the U.S. has fewer HPV infections from strains that cause cervical cancer and warts.
/ Source: TODAY

People with a cervix might notice a change on their next visit to the OB-GYN thanks to new guidelines about cervical cancer screenings. These new rules aim to reduce stress and increase detection of the virus that causes most cervical cancers.

The American Cancer Society's updated cervical cancer screening requirements now suggest that people with a cervix undergo human papillomavirus virus (HPV) primary testing — instead of a Pap test — every five years, starting at age 25 and continuing through 65. More frequent Pap tests (every three years) are still considered acceptable tests for offices without access to HPV primary testing. The previous ACS guidelines, released in 2012, advised screening to begin at age 21.

"Women can start (testing) later. They can do it less frequently," said Dr. Alexi Wright, director of gynecologic oncology outcomes research at Dana-Farber Cancer Institute in Boston, who was not involved in developing the updated recommendations. "The test is (detecting) the virus that causes cervical cancer and whether a woman has an infection or not. It allows us to better understand her risk for developing cervical cancer."

The U.S. Preventative Task Force and the American College of Obstetricians and Gynecologists (ACOG) recommendations currently differ from the ACS guidelines. They encourage Pap tests every three years from ages 21 to 29, then co-testing of Pap test and HPV primary test from 30 to 65 every five years, or only a Pap test every three years.

In a statement shared with TODAY, ACOG said they look forward to reviewing the new ACS recommendations to determine if they should update their clinical guidance.

"In the interim, ACOG affirms our current cervical cancer screening guidelines, which encompass all three cervical cancer screening strategies (high-risk human papillomavirus testing alone, cervical cytology alone and co-testing)," wrote Dr. Christopher M. Zahn, vice president of practice activities at ACOG. " ... Current screening guidelines reflect a balance of benefit and potential harms and support shared decision-making between patients and their clinicians."

Both Pap tests and HPV tests requires cells collected from around the cervix, so the collection experience remains similar.

Pap tests detect changes in the cells of the cervix and are somewhat unreliable. Wright said there's a 50-50 chance they'll miss an important change or incorrectly flag cells as abnormal. But the HPV primary test detects the virus, which accounts for 99% of cervical cancers. If tests are positive, doctors can better understand the patient's cancer risk.

"The update is based on decades of studies comparing the effectiveness of HPV testing compared to (Pap tests)," Debbie Saslow, managing director, HPV & GYN cancers with the American Cancer Society told TODAY, via email.

This provides relief to people as they anticipate fewer unclear and stressful Pap test results.

"Giving women more certainty, with a more accurate test, can really be helpful," Wright said. "A lot of anxiety — which is serious — can happen around tests that are seen as abnormal but may not actually be significantly abnormal."

While first screening at 25 instead of 21 might seem as if it might miss younger people at risk for cervical cancer, Saslow said that's not true. Less than 1% of cervical cancers are detected under age 25 — amounting to about 130 a year.

"This number is decreasing thanks to HPV vaccination," she said. "These cases have not decreased as a result of screening, and the numbers are similar in countries that start screening later. Screening is just not beneficial at this age."

Over the past 40 years, the rate of cervical cancer and deaths from it have decreased significantly, according to the Centers for Disease Control and Prevention. While screening has helped, the HPV vaccine has contributed to the decline. When it comes to teen girls, infections with cancer and wart-causing HPV strains dropped 86% and among young women these infections are down 71%, according to the CDC. The latest estimates show that 60% of adolescent girls and 42% of adolescent boys have received one or more doses of HPV vaccine. Wright urges parents to get their children the vaccine to prevent head, neck, cervical, penile and anal cancers.

"This is a vaccine that's designed to prevent cancer," Wright said. "My hope is that by doing the combination of vaccinating and screening and treating that will be able to eradicate (HPV-causing cancers) in this country."

This story was updated on July 30, 2020 to include a comment from the American College of Obstetricians and Gynecologists (ACOG) and current HPV vaccination rates.