Kimberly K. Vesco, MD, MPH; Evelyn P. Whitlock, MD, MPH; Michelle Eder, PhD; Brittany U. Burda, MPH; Caitlyn A. Senger, MPH; Kevin Lutz, MFA
Vesco KK, Whitlock EP, Eder M, Burda BU, Senger CA, Lutz K. Risk Factors and Other Epidemiologic Considerations for Cervical Cancer Screening: A Narrative Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:698-705. doi: 10.7326/0003-4819-155-10-201111150-00377
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Published: Ann Intern Med. 2011;155(10):698-705.
Despite the success of cervical cancer screening programs, questions remain about the appropriate time to begin and end screening. This review explores epidemiologic and contextual data on cervical cancer screening to inform decisions about when screening should begin and end.
Cervical cancer is rare among women younger than 20 years. Screening for cervical cancer in this age group is complicated by lower rates of detection and higher rates of false-positive results than in older women. Methods used to diagnose and treat cervical intraepithelial neoplasia have important potential adverse effects. High-risk human papillomavirus infections and abnormalities on cytologic and histologic examination have relatively high rates of regression. Accordingly, cervical cancer screening in women younger than 20 years may be harmful.
The incidence of, and mortality rates from, cervical cancer and the proportion of U.S. women aged 65 years or older who have had a Papanicolaou smear within 3 years have decreased since 2000. Available evidence supports discontinuation of cervical cancer screening among women aged 65 years or older who have had adequate screening and are not otherwise at high risk. Further reductions in the burden of cervical cancer in older women are probably best achieved by focusing on screening those who have not been adequately screened.
Surveillance Epidemiology and End Results (SEER) data for incident cases among females aged 15 to 19 years and 50 to 64 years. Data are from references (Surveillance Epidemiology and End Results (SEER) data for incident cases among females aged 15 to 19 years and 50 to 64 years. Data are from references 27 and 45. HPV = human papillomavirus.) and (Surveillance Epidemiology and End Results (SEER) data for incident cases among females aged 15 to 19 years and 50 to 64 years. Data are from references 27 and 45. HPV = human papillomavirus.). HPV = human papillomavirus.
High-risk HPV types are 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68. Data are from reference (High-risk HPV types are 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68. Data are from reference 25. Reproduced with permission from Macmillan Publishers, British Journal of Cancer, copyright 2004. CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus.). Reproduced with permission from Macmillan Publishers, British Journal of Cancer, copyright 2004. CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus.
Mortality rates are from 2000–2007 data. Data are from reference (Mortality rates are from 2000–2007 data. Data are from reference 45.).
The incidence and prevalence of high-grade cervical lesions and cancer decreased with age and, in general, those over the age of 65 years had the lowest burden of disease. The age-related decrease in cervical disease was similar in previously unscreened women. There was no difference in the aggressiveness of invasive cancers in older women. Repeat screening after negative smears was associated with a reduced risk of high-grade cytologic abnormalities.
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