By Lisa Larkin, MD, FACP, NCMP, IF
Founder and CEO, Ms.Medicine
The American Cancer Society has just released (July 30, 2020) new cervical cancer screening guidelines for women, and the new recommendations indicate a promising trend: the HPV vaccine is working to prevent HPV and cervical cancer.
The new guidelines call for fewer screenings and a more simplified approach to screening, based on the decrease in cases of precancerous changes in the cervix—attributed to more frequent HPV vaccinations. However, the new guidelines differ from those of other key organizations, so patients should work with their doctor.
First, what is HPV?
HPV – short for human papilloma virus – is a very common, sexually transmitted virus that can lead to several types of cancers. HPV is so common that researchers estimate that nearly 80 million Americans have been infected with some type of HPV in their lifetime. According to the CDC, most (9 out of ten) HPV infections resolve on their own within two years. However, some infections can last longer and can lead to pre-cancerous conditions or cancer of the cervix, vagina or vulva in women (as well as cancer of the penis, anus or throat.) Almost 100% of cervical cancer cases are related to HPV infection.
What are the HPV vaccination guidelines?
Current CDC guidelines recommend all boys and girls get two doses of the HPV vaccine at ages 11–12, although the vaccination can be started as early as age 9. For the HPV vaccine to be most effective, the series should be given prior to exposure to HPV. In 2019, new information lead to the additional recommendations that those who had not received the vaccine as an adolescent should receive a “catch up” vaccine (up to age 26). For those between ages 27 and 45 who had not been previously vaccinated, the CDC suggests discussing the risks/benefits of a “catch up” vaccine with your healthcare provider.
What are the new cervical cancer screening guidelines from the American Cancer Society?
Cervical cancer screening is a complex topic: there are three ways physicians can screen: an HPV test alone, a Pap test, or a combination of the two, often called “co-testing.” The ACS’s new guidelines suggest that women undergo primary HPV testing (without a Pap test) every five years, starting at age 25 (previous guidelines suggested HPV testing begin at age 30), and that screening for cervical cancer begin at age 25 (previous recommendations were to begin at age 21.) The ACS’s new guidelines refer to HPV testing alone. However, many in the medical community believe co-testing is the most thorough method of screening.
It’s also important to know that the current guidelines from the U.S. Preventative Taskforce and the American College of Obstetrics and Gynecology (ACOG) differ from the American Cancer Society’s newest statement. The USPTF and ACOG’s guidelines recommend a Pap test every three years from ages 21 – 29, then co-testing every five years, or a Pap-only test every three years (depending on the women’s history, previous test results and lab capabilities.) The important finding is that the HPV vaccine has been effective in preventing precancerous cells and cases of cervical cancer. Parents should be sure to speak with their pediatricians about HPV vaccinations, and women should work with their healthcare providers to determine the best cervical cancer screening schedule for them.