January 9, 2015 — The American Society for Colposcopy and Cervical Pathology and the Society of Gynecological Oncology on Thursday issued an interim guidance report recommending that women be screened for cervical cancer starting at age 25 using the human papillomavirus test before potentially using Pap tests, Reuters reports.
Meanwhile, the American College of Obstetricians and Gynecologists said that it continues to support its current recommendations, which align with those issued by the U.S. Preventive Services Task Force and include Pap testing (Seaman, Reuters, 1/8).
The interim guidance was published in Gynecologic Oncology, the Journal of Lower Genital Tract Disease and Obstetrics and Gynecology (Preidt, HealthDay/U.S. News & World Report, 1/9). The recommendations were developed after a review of 11 studies (Reuters, 1/8).
FDA in April 2014 approved the Cobas HPV test, the first alternative to the Pap test as a primary screening method for cervical cancer, despite opposition from some medical, consumer and women's groups.
The test screens cervical samples for the presence of HPV, which causes the majority of cervical cancer cases. By comparison, the Pap test involves examining a cervical sample under a microscope to look for abnormalities.
FDA approved the Cobas test in 2011 for use in conjunction with the Pap test. The latest approval permitted Roche to market Cobas for use on its own as a primary screening method for women ages 25 and older, with Pap tests only being necessary in certain cases as a follow up (Women's Health Policy Report, 4/25/14).
Interim Guidance Details
The interim guidance recommends that, starting at age 25, women should undergo screening for cervical cancer using the HPV test, which it says is an effective alternative to the Pap test or the two tests in combination.
If the HPV test is negative, the interim guidance says that women should not undergo a screening for an additional three years. If women test positive for HPV strains 16 and 18, which are the most likely types to cause cancer, ASCCP and SGO recommend that health care providers follow up with a colposcopy, a procedure to visually examine the cervix (HealthDay/U.S. News & World Report, 1/9). If the HPV test is positive for other strains, the interim guidance recommends that women undergo a Pap test.
The interim guidance recommends that women younger than age 25 follow USPSTF's current guidelines for cervical cancer screening.
ACOG Sticking to Current Recommendations
ACOG, which had a representative on the panel that developed the new guidance, said that it continues to support its current recommendation of a Pap test for women ages 21 through 65 every three years to screen for cervical cancer or a Pap test in combination with an HPV test every five years for women ages 30 to 65 (Reuters, 1/8).
ACOG said that it is not recommending an HPV test-only approach at this time because infection with HPV occurs often among younger women and frequently resolves on its own. Therefore, ACOG said that a positive result from an HPV test could lead to women undergo an unnecessary amount of follow-up tests.
ACOG said that while it might be the case that the HPV test could replace the Pap test as a first option for testing at age 25, there was not sufficient evidence to recommend that it "should" (HealthDay/U.S. News & World Report, 1/9).