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U.S. Preventive Services Task Force, American Cancer Society, ACOG Release Draft Cervical Cancer Screening Guidelines

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In October 2011, the U.S. Preventive Services Task Force (USPSTF) published draft cervical cancer screening guidelines that led to cheers along with a bit of head-scratching.

The USPSTF is a panel of medical experts that issues recommendations for primary health care providers (like the family doctor or nurse) to follow in delivering preventive health care services, such as guidance on screening for cervical cancer (including Pap tests). The current Task Force recommendations for cervical cancer screening were issued in 2003.

The proposed guidelines recommend:

  • Screening for cervical cancer with cytology (Papanicolaou [Pap] smear) every 3 years in women ages 21 to 65 years who have had vaginal intercourse and have a cervix. This includes a recommendation for the use of liquid-based cytology with Pap tests. Unlike conventional cytology (Pap smears) that involve samples being placed on a glass slide, cells collected for LBC are placed in a vial with a special liquid. An advantage of LBC is that labs receive fewer unsatisfactory specimens. Currently, about 95% of Pap tests are done with liquid-based cytology. This rating ensures that women who receive LBC will have access to Pap tests without co-pays.
  • Against screening for cervical cancer in women younger than age 21 years, regardless of sexual history.
  • Against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
  • Against screening for cervical cancer in women who have had a total hysterectomy for benign disease.
  • Against screening for cervical cancer using human papillomavirus (HPV) testing, alone or in combination with cytology, in women younger than age 30 years.

The Task Force also concludes there is insufficient evidence (an “I” statement) to recommend HPV testing – either alone or in conjunction with a Pap test – be included as part of cervical cancer screening for women 30 and older. The “I” statement about the benefits of HPV testing goes against recommendations issued over the summer by the Institute of Medicine (IOM) that called for access to HPV tests for women age 30 and older.

The Task Force’s lack of a recommendation for Pap/HPV testing for women over 30 is also inconsistent with guidelines recently issued by both the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG). The Task Force, ACS, and ACOG released their proposed cervical cancer screening guidelines simultaneously.

The IOM recommendations trigger a provision of the Affordable Care Act requiring insurance plans to cover HPV co-testing for women 30 and older with no cost-sharing or co-pay. Medicaid coverage is tied to USPSTF A and B recommendations, though, and the Task Force’s “I” recommendation means women receiving benefits through Medicaid (who are more likely to be low-income) would have to fork over a co-pay for the HPV testing, effectively forcing women with the least to pay the most. The Task Force is accepting comments about the proposed guidelines through November 30 at: U.S. Preventive Services Task Force