The American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology recently collaborated in updating cervical cancer screening guidelines. The three organizations now advise that women who are age 65 and older and have a history of normal Pap test results no longer need to continue Pap testing. This means that women will undergo fewer screenings over their lifetime. The guidelines also call for the combination of human papillomavirus (HPV) and Pap testing for women who are age 30 and older. The U.S. Preventive Services Task Force (USPSTF) also recently released its cervical cancer screening recommendations, and reaffirmed that the Pap test as the best way to detect cervical cancer among women aged 21-65. However, the USPSTF does not recommend HPV testing of women under the age of 30 because evidence is still lacking on the risks and benefits of HPV testing in this age group.
The USPSTF reviewed current evidence-based research in revising its recommendations, and the Task Force’s reviews were published in the October 18, 2011 issue of the Annals of Internal Medicine.
To compare the Pap test against the HPV test, researchers reviewed 4 studies of 142,000 women and found that HPV testing, on its own, yields too many false positives that result in unnecessary testing, anxiety and additional healthcare costs. Therefore, HPV testing is more sensitive, but less specific than the Pap test. Another review article examined the appropriate ages to start and stop cervical cancer screening, and its authors concluded that screening for cervical cancer should continue to begin at age 21, and if a woman aged 65 or older has had normal Pap test results and is not considered high risk for cervical cancer, she can stop screening at age 65. Older woman who are considered at high risk for cervical cancer include those who have had previous high-grade cervical lesions or a history of cervical cancer.