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JAMA. 2018 Aug 21;320(7):674-686. doi: 10.1001/jama.2018.10897.

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Author information

1
University of Iowa, Iowa City.
2
Fairfax Family Practice Residency, Fairfax, Virginia.
3
Virginia Commonwealth University, Richmond.
4
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
5
Stanford University, Stanford, California.
6
Harvard Medical School, Boston, Massachusetts.
7
Oregon Health & Science University, Portland.
8
Columbia University, New York, New York.
9
University of Pennsylvania, Philadelphia.
10
Virginia Tech Carilion School of Medicine, Roanoke.
11
Nationwide Children's Hospital, Columbus, Ohio.
12
Temple University, Philadelphia, Pennsylvania.
13
University of Alabama at Birmingham.
14
University of California, Los Angeles.
15
Brown University, Providence, Rhode Island.
16
Boston University, Boston, Massachusetts.
17
Northwestern University, Evanston, Illinois.
18
University of Hawaii, Honolulu.
19
Pacific Health Research and Education Institute, Honolulu, Hawaii.
20
Tufts University, Medford, Massachusetts.

Abstract

Importance:

The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

Objective:

To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

Evidence Review:

The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

Findings:

Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

Conclusions and Recommendation:

The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer. (D recommendation).

Summary for patients in

PMID:
30140884
DOI:
10.1001/jama.2018.10897
[Indexed for MEDLINE]

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