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Press Release Date: January 22, 2003
The U.S. Preventive Services Task Force today strongly recommended that women between the ages of 21 and 65 be screened regularly for cervical cancer, but it 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. Pap testing followed by appropriate treatment can effectively prevent invasive cervical cancer by detecting precancerous lesions before they grow and spread.
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. In its statement released today on the AHRQ Web site, the Task Force considered a woman's age, her medical history, and the screening method used. These recommendations are largely consistent with the recommendations of the American Cancer Society and related organizations. 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 it 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 non-cancerous 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 may also 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.
"Today, most cervical cancer occurring in the United States is in women who have never been screened or who do not receive appropriate followup after an abnormal Pap smear. The greatest potential to reduce cervical cancer deaths will come from efforts to improve screening and followup for these women," said Task Force Chair Alfred Berg M.D., M.P.H., Professor and Chair, Department of Family Medicine, University of Washington, Seattle. "Clinicians, hospitals, and health plans have a responsibility to develop systems to identify and screen women who have had inadequate screening or followup."
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 Task Force recommendations for cervical cancer screening are an "A" for sexually active women with a cervix; a "D" for women over the age of 65; a "D" for women who have had a total hysterectomy for a non-cancerous condition; an "I" for routine use of new technologies; and an "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. The cervical cancer screening recommendation and materials for clinicians are available at http://www.uspreventiveservicestaskforce.org/3rduspstf/cervcan/cervcanrr.htm. 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 by calling (800) 358-9295 or sending an E-mail to AHRQPubs@ahrq.hhs.gov. Clinical information is also available from the National Guideline Clearinghouse™ at http://www.guideline.gov. More information on cervical cancer is available from the National Cancer Institute at http://www.cancer.gov.
For more information, please contact AHRQ Public Affairs, (301) 427-1364: Farah Englert, (301) 427-1865 (FEnglert@ahrq.gov).