USPSTF Plans Changes to Cervical Cancer Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) plans to add self-collected human papillomavirus (HPV) testing to its recommendations for cervical cancer screening, among other changes.

Task Force Chair Wanda Nicholson, MD, MPH, MBA, of the Milken Institute School of Public Health and George Washington University School of Medicine in Washington D.C., said evidence shows that patient self-collection and clinician collection yields similar results.

“There’s no difference in accuracy, and in fact, the self-collection can promote higher screening rates among women who are either under-screened or [have] never been screened,” Nicholson told MedPage Today.

While self-collection was on the Task Force’s radar for many years, it has not previously been part of the USPSTF cervical screening recommendations. In May, the FDA approved swab-based self-collection for HPV testing in healthcare settings, though ob/gyns told MedPage Today this option does not entirely replace the utility of Pap smears and the U.S. still lags behind other nations in self-collection outside healthcare facilities.

Nicholson also noted that most women with cervical cancer are either under-screened or had never been screened, and that African American, Hispanic, American Indian, and Alaska Native women — as well as women living in rural areas — die from cervical cancer at higher rates. The Task Force hopes that adding self-collection will improve screening among these at-risk populations.

Jessica Kingston, MD, of UC San Diego Health, who was not part of the Task Force, told MedPage Today that self-collection makes screening more inclusive to people wary of the speculum or who have had traumatic experiences.

“Most healthcare professionals think [getting a Pap test] should be just part of someone’s routine of staying healthy, but many people find that a big hurdle to come over,” Kingston noted. “With self-collection, we’re really kind of combining what we know about what causes cervical cancer and making it much more feasible for a wider population.”

Much of the rest of the draft recommendation statement aligns with previous recommendations, which were last updated in 2018. There are no planned changes for women ages 21 to 29, who still should be screened for cervical cancer every 3 years with cervical cytology, the draft statement said.

Women ages 30 to 65 should be screened with an HPV test every 5 years, either with clinician or patient-self collection. However, the Task Force also emphasized that getting a Pap test every 3 years, or co-testing with a combined HPV and Pap test every 5 years, are effective alternative screening options for this group. In the updated draft recommendation statement, all these options still received an A grade recommendation.

“What’s new and different is that we have identified HPV as being an optimal screening test in the sense that it has the best balance of benefits and harms,” Nicholson said, meaning it detected early signs of cervical cancer with fewer unnecessary follow-up tests.

Additionally, some groups still don’t need to be screened for cervical cancer. This includes women younger than 21, women who have had a total hysterectomy and don’t have a history of cervical cancer or a high-grade precancerous lesion, and women older than 65 who previously had regular screenings with normal results and are not otherwise at high risk for cervical cancer, all of which get a D grade recommendation.

For this review, the task force considered 81 fair- to good-quality studies. Of these, 19 looked at benefits or harms of HPV-based screening strategies, 22 looked at the accuracy of self-collection in HPV tests, 42 reported on uptake of self-collected HPV tests, and one trial assessed diagnostic accuracy and uptake.

The recommendations apply to cisgender women and people assigned female at birth, including transgender men and some nonbinary people. They do not apply to people with increased risk of developing cervical cancer, including women with HIV, those with compromised immune systems, or those with a history of precancerous lesions or cervical cancer. People with these risk factors should receive condition-specific management.

Supporting evidence for the USPSTF recommendations, including a draft evidence review and modeling report, were posted for public comment on the Task Force website. Comments can be submitted online through Jan. 13, 2025.