Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Abstract

The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

Cancer Statistics, 2021

“…Although cervical cancer incidence has declined for decades overall, distant‐stage disease and cervical adenocarcinoma, which is often undetected by cytology, are increasing, largely driven by trends in young women 93 . These findings underscore the need for more targeted efforts to increase both HPV vaccination among all individuals aged ≤26 years and primary HPV testing or HPV/cytology cotesting every 5 years among women beginning at age 25 years, as recommended by the American Cancer Society in updated guidelines published in 2020 94,95 …”

Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature

“…The recommendations were shared, until July 2020, by the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) ( Table 6 ) [ 7 , 8 ]. In July 2020, the ACS produced a guideline update that leads to substantial changes [ 10 ]. Until July 2020, the ACS was in accordance with other American societies.…”

“…Since HPV DNA testing has been introduced for cervical cancer screening in women aged 30 to 65 years both in the American and in the European guidelines [ 5 – 10 ] and the costs of the new assays have declined and become affordable, HPV tests are being more frequently used in situations where they are not needed. It is well known that the natural history of HPV infections implies frequent clearance of the virus in immunocompetent patients, as well as high rates of spontaneous regression of low-grade lesions [ 11 – 13 ].…”

Novel blood-based early cancer detection: diagnostics in development

“…For instance, short-term plans without preventive service benefits or coverage that requires patients to pay out of pocket if a screening becomes diagnostic provides negative financial incentives for screening. 16,17 Patients may incur high out-of-pocket costs, which can be become a deterrent to screening.…”

“…Prostate CancerThe diagnosis of prostate cancer does not always require treatment; thus, early detection of prostate cancer may lead to overdiagnosis, unnecessary treatment, patient anxiety, and avoidable costs. 20 NCCN Select Cancer Screening Recommendations5,7,[13][14][15]17,18 have a grade C recommendation for early detection of prostate cancer: with early detection offered only when patients fully understand benefits and the risks of participating, which is similar to the USPSTF recommendations. 20 Prostate-specific antigen (PSA)is one method of detection and is measured in a blood test, while a digital rectal exam (DRE) is a physical exam that may be used in conjunction with the PSA level.…”