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

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Cervical cancer screening guidelines recommend starting at age 21 with cytology every 3 years, or at age 30 with cytology, high-risk human papillomavirus (hrHPV) testing, or cotesting every 3-5 years. Screening is not recommended for women younger than 21 or older than 65 with adequate prior screening.

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Public Health

Background:

  • Cervical cancer deaths have declined due to screening.
  • The US Preventive Services Task Force (USPSTF) updated its 2012 recommendations.
  • Evidence on screening methods and intervals was reviewed.

Purpose of the Study:

  • To update USPSTF recommendations for cervical cancer screening.
  • Evaluate screening strategies including high-risk human papillomavirus (hrHPV) testing and cytology.
  • Determine optimal screening ages, intervals, and compare benefits and harms.

Main Methods:

  • Systematic review of clinical trials and cohort studies.
  • Evaluation of screening with hrHPV testing alone, cytology alone, or cotesting.
  • Decision analysis modeling for screening parameters and strategies.

Main Results:

  • Screening reduces cervical cancer incidence and mortality in women aged 21-65.
  • Benefits of screening outweigh harms for women aged 21-65.
  • High certainty that benefits outweigh harms for cytology alone (21-29 yrs) and cytology, hrHPV, or cotesting (30-65 yrs).

Conclusions:

  • Recommend screening every 3 years with cytology for women aged 21-29.
  • Recommend screening every 3 years with cytology, every 5 years with hrHPV, or every 5 years with cotesting for women aged 30-65.
  • Recommend against screening for women <21, >65 (with adequate screening), or post-hysterectomy without history of high-grade lesions.