Pap testing, the standard for cervical cancer prevention for decades, will become obsolete under a new guideline from the American Cancer Society (ACS), replaced by testing for human papillomaviruses (HPV), the cause of cervical cancer. This shift follows declining cervical cancer risk in young women resulting from HPV vaccination over the past 15 years.
The rarity of cervical cancer in young women also allows them to wait to begin screening until age 25 and to obtain screening only every five years. HPV testing is obtained by pelvic exam, just like Pap testing.
Previously, the ACS recommended that women ages 21-29 receive a Pap test every three years and that women ages 30-65 receive HPV testing and a Pap test every five years. Pap testing alone and Pap and HPV co-testing both remain options as clinicians and labs transition to HPV-only screening methods, according to the new ACS guideline.
The shift away from the Pap test “reflects the rapidly changing landscape of cervical cancer prevention in the United States, calling for less and more simplified screening,” according to the ACS. Studies show that HPV testing is more accurate than the Pap test and can be done less often, the group said.
The new guideline, announced July 30, 2020, appears in the ACS flagship journal, CA: A Cancer Journal for Clinicians.
The HPV test doesn’t detect cancer but rather the viral infection behind virtually all cases of cervical cancer. Nearly all men and women will get one strain of HPV or another over their lifetime, according to the Centers for Disease Control and Prevention (CDC), and nine out of 10 HPV infections disappear on their own within two years.
A negative HPV test is linked to a cervical cancer risk that remains very low for many years. In individuals with a cervix, a persisting HPV infection can, but doesn’t necessarily, lead to cervical cancer. Women who test positive for HPV need further assessment, which may include repeat testing after a year or colposcopy, a procedure to inspect the cervix to identify precancerous changes.
“We are finally seeing the benefits of widespread HPV vaccination as girls grow old enough to begin screening,” said L. Stewart Massad Jr., MD, a Washington University professor of obstetrics and gynecology at Siteman Cancer Center. “Cervical cancer and precancer rates have fallen among women under age 30, allowing us to make this momentous shift.”
A vaccine against HPV has been in use for nearly 15 years, and more than half of eligible adolescents and young women in the U.S. are now vaccinated and protected from the majority of cervical cancers. This has led to a drop in rates of precancerous cervical changes, the precursors to cervical cancer, in women younger than 25. Also, most HPV infections in women ages 21 through 24 become undetectable in one to two years, according to the ACS, leading to the older recommended age for initial testing.
Learn more about the new guideline here: https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21629.