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Screening for Cervical Cancer: Recommendations From the U.S. Preventive Services Task Force FREE

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The full report is titled “Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 19 June 2012 issue of Annals of Internal Medicine (volume 156, pages 880-891). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

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Ann Intern Med. 2012;156(12):I-44. doi:10.7326/0003-4819-156-12-201206190-00003
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Cervical cancer is cancer of the lower part of the uterus or womb. Infection with human papillomavirus (HPV) is associated with most cases of cervical cancer. People get the virus by having unprotected sexual intercourse with an HPV-infected person.

Papanicolaou (Pap) smears are used to screen for cervical cancer before a person has symptoms. To perform a Pap smear, doctors use a swab during an internal examination of the vagina to take a sample of cells from the cervix to examine under a microscope. In conventional Pap smears, samples are smeared directly onto a microscope slide. In liquid-based cytology Pap smears, the sample is put in a bottle of preservative and is then smeared onto the slide. If abnormal cells are found, the patient is sent for colposcopy, which allows doctors to look at the cervix with magnification and take larger samples of abnormal areas.

Pap smears can find cervical cancer at early, treatable stages. It is also possible to test for HPV in combination with Pap smears to detect cervical cancer.

The USPSTF sought to update its 2003 recommendations on cervical cancer screening to reflect information that has since become available.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research published since 2003 that evaluated tests of liquid-based cytology and HPV testing. It also commissioned researchers to develop a computer model to clarify the optimal frequency of and best ages to start and stop cervical cancer screening.

What did the authors find?

Both types of Pap smears had similar accuracy. False-positive HPV test results were common before age 30 years. Available studies show that precancer or cancer is rare before age 20 years. The computer model showed that screening every 3 years saves nearly as many lives as screening every year, with fewer colposcopies. It also showed no benefit of screening beyond age 65 years in women who have had prior screening.

What does the USPSTF recommend that patients and doctors do?

Women aged 21 to 65 years should be screened with Pap smear (either type) every 3 years.

Women aged 30 to 65 years who want less frequent screening can get a Pap smear plus HPV testing every 5 years.

Women younger than 30 years should not get screening that includes HPV testing.

Women younger than 21 years should not get cervical cancer screening.

Women older than 65 years who have had adequate previous screening should not get cervical cancer screening.

Women who have had a hysterectomy (including removal of the cervix) and have no history of cancer or precancerous abnormalities should not get cervical cancer screening.

What are the cautions related to these recommendations?

These recommendations do not apply to women who have had a previous abnormal Pap smear; women who have a problem with their immune system, such as HIV infection; or women whose mothers took diethylstilbestrol when pregnant with them.





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