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The U.S. Preventive Services Task Force recently issued recommendations related to cervical cancer screening and screening for diabetes in adults and in pregnant women.
The Task Force, the leading independent panel of private-sector experts in prevention and primary care, is sponsored by the Agency for Healthcare Research and Quality. The Task Force conducts rigorous impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.
The Task Force grades the strength of evidence as "A" (strongly recommends), "B" (recommends), "C" (no recommendations for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against screening). The new screening recommendations for cervical cancer and diabetes are described here.
Cervical cancer screening. The Task Force recently issued a strong recommendation that women between the ages of 21 and 65 be screened regularly for cervical cancer. However, they have concluded that some women can safely discontinue regular screening or can be screened less frequently.
For women age 65 and over who have had regular normal Pap smears, the Task Force concluded that the harms of continued routine screening such as false positive tests and invasive procedures may outweigh the benefits. For younger women who have had at least two normal annual screenings, the Task Force found no evidence that annual screening achieves better outcomes than screening every 3 years. These recommendations are largely consistent with the recommendations of the American Cancer Society and related organizations.
Pap testing followed by appropriate treatment can effectively prevent invasive cervical cancer by detecting precancerous lesions before they grow and spread.
The Task Force considered a woman's age, her medical history, and the screening method used. Specifically, the Task Force:
- Strongly recommends starting to screen women 3 years after they begin sexual activity, or at the age of 21, whichever comes first. (This is a change from the previous Task Force recommendation that stated screening should begin at age 18.) The Task Force concluded that screening should be performed at least every 3 years, but they noted that annual screening is appropriate until a woman has had at least two to three consecutive normal Pap test results.
- Recommends against screening women 65 and older who have had adequate recent screenings with normal Pap smears and are not otherwise at increased risk for cervical cancer.
- Recommends against screening women who have had a total hysterectomy for a noncancerous condition.
- Concludes that the evidence is insufficient to recommend for or against using new technologies, such as liquid-based cytology, instead of conventional Pap smears to screen for cervical cancer. The evidence available for newer screening technologies does suggest that these methods are slightly more sensitive, but they also may be more likely to give false-positive results. It is not clear whether the possible benefits, if any, would be large enough to justify the added costs.
- Concludes that the evidence is insufficient to recommend for or against the use of human papillomavirus testing as a primary screening tool for cervical cancer. Trials are currently under way to clarify the use of HPV testing in cervical cancer screening.
Cervical cancer, the 10th leading cause of cancer death, is linked to HPV, which is generally acquired through sexual contact. Risk factors for cervical cancer include early onset of sexual intercourse, having many sexual partners, and infection by a high-risk strain of HPV. The U.S. Congress has designated January as National Cervical Cancer Awareness Month.
The revised Task Force recommendations reinforce recently released guidelines of the American Cancer Society, which also concluded that older women and women who have had a total hysterectomy for a noncancerous condition can discontinue screening, and that less frequent screening is appropriate for middle-aged women. In addition, the ACS also recommends annual screening until age 30 and screening once every 2-3 years after age 30. The Task Force found no direct evidence that annual screening achieves better outcomes than screening every 3 years.
The Task Force recommendations for cervical cancer screening are "A" for sexually active women with a cervix; "D" for women over the age of 65; "D" for women who have had a total hysterectomy for a noncancerous condition; "I" for routine use of new technologies; and "I" for HPV testing.
The Task Force based its conclusions on reviews by a team led by Katherine E. Hartmann, M.D., Ph.D., at AHRQ's Evidence-based Practice Center at RTI International-University of North Carolina.
Select to access the cervical cancer screening recommendation and materials for clinicians.
More information on cervical cancer is available from the National Cancer Institute.
Screening for diabetes. On February 3, the Task Force issued two recommendations on screening for diabetes in adults and pregnant women. They recommended that adults with high blood pressure or high cholesterol be screened for type 2 diabetes (insulin-resistant diabetes) as part of an integrated approach to reduce cardiovascular disease but concluded that further research is needed to determine whether widespread screening of the general population would improve health outcomes. In a separate recommendation, the Task Force found insufficient evidence to recommend for or against routine screening for gestational diabetes in asymptomatic pregnant women.
The Task Force based its conclusions on reports from teams at AHRQ's Evidence-based Practice Center at RTI International-University of North Carolina. The gestational diabetes report was led by Seth Brody, M.D., and the type 2 diabetes report was led by Russell Harris, M.D., M.P.H. The recommendations on screening for type 2 diabetes are published in the February 4 issue of the Annals of Internal Medicine. The gestational diabetes recommendation is published in the February issue of the journal Obstetrics & Gynecology (also known as The Green Journal).
Type 2 diabetes is the most common form of diabetes. Patients with type 2 diabetes are at high risk for heart disease and stroke, and over time they may develop eye, kidney, or nerve problems. Type 2 diabetes is estimated to affect approximately 16 million Americans—11.1 million who have been diagnosed and as many as 5.9 million who have not. Although diabetes frequently is accompanied by symptoms such as fatigue or excessive thirst or urination, it often is silent in its early stages. People at increased risk for diabetes include those who are obese; those who have a relative in their immediate family with the disease; and blacks, Hispanics, American Indians, and Alaska Natives.
Gestational diabetes is a condition characterized by elevated blood sugar brought on by pregnancy. It occurs in approximately 2 percent to 5 percent of all pregnancies. Women who are older than 25, have had gestational diabetes in a previous pregnancy, or have a family history of diabetes are at higher risk for developing the disease. Black, Hispanic, American Indian, and South or East Asian women are also at increased risk. Women with gestational diabetes are more likely to have large babies, which may lead to complications during labor or the need for cesarean sections. According to the Task Force, it is not known whether small blood sugar elevations found in the majority of women with gestational diabetes have adverse effects for mother and/or infant.
The Task Force recommendations for type 2 diabetes screenings are a "B" for those with high blood pressure or high cholesterol and an "I" for screening asymptomatic adults. The Task Force recommendation for gestational diabetes screening is an "I" for screening asymptomatic pregnant women.
For more information on the general diabetes recommendations, see "Screening for type 2 diabetes mellitus in adults: Recommendations and Rationale," by the U.S. Preventive Services Task Force, in the February 4, 2003, Annals of Internal Medicine 138(3), pp. 212-214; and "Screening adults for type 2 diabetes: A review of the evidence for the U.S. Preventive Services Task Force," by Russell Harris, M.D., M.P.H., Katrina Donahue, M.D. M.P.H., Saif S. Rathore, M.P.H., and others, in the same journal, pp. 215-229.
For more information on the gestational diabetes recommendation, see "Screening for gestational diabetes mellitus: Recommendations and rationale," by the U.S. Preventive Services Task Force, in the February 2003 Obstetrics & Gynecology 101(2), pp. 393-395; and "Screening for gestational diabetes: A summary of the evidence for the U.S. Preventive Services Task Force," by Seth C. Brody, M.D., Russell Harris, M.D., M.P.H., and Kathleen Lohr, Ph.D., in the same journal, pp. 380-392.
Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse.
Clinical information is also available from the National Guideline Clearinghouse™.
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