October 19, 2011; U.S. Preventive Services Task Force (USPSTF) makes recommendations for cytology and HPV testing for our nation.
Given that the U.S. Preventive Services Task Force (USPSTF) is currently open to accepting comments on their recommendations, it would be very valuable if you might take some time to look over the recommendations and submit comments. Comments can be submitted until November 16thon the USPSTF website, at http://www.uspreventiveservicestaskforce.org.
Cervical Cancer-Free America is available is you have any questions or would like discuss details of these recommendations. Please also feel free to send your comments to us at ccfa@unc.edu.
Please kindly see an explanation from Deborah Arrindell, Vice President, Health Policy at the American Social Health Association (debarrindell@aol.com).
***** APOLOGIES FOR CROSS POSTING — PLEASE SHARE WIDELY WITHIN YOUR NETWORKS****
October 19, 2011
Dear Cervical Cancer Prevention Colleague, Today the U.S. Preventive Services Task Force (USPSTF) published draft cervical cancer screening guidelines (http://www.uspreventiveservicestaskforce.org/). These guidelines will be open for public comment until November 16, 2011.
In addition, the American Society for Colposcopy and Cervical Pathology (ASCCP), American Cancer Society (ACS), and American Society for Clinical Pathology posted draft cervical cancer screening recommendations on the ASCCP website: http://www.asccp.org/PracticeManagement/PICSM/TheRoleofMolecularTestingSymposium/tabid/9856/Default.aspx These guidelines will be open for comment until November 9, 2011. The topline recommendations from the ACS, ASCCP, ASCP, are attached in a format that may be easier to navigate than the website.
Also attached is an FAQ, developed by the American Cancer Society that may be helpful as we try to better understand the impact and potential of these recommendations.
USPSTF Draft Recommendation
The U.S. Preventive Services Task Force (USPSTF) recommends 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 is an A recommendation http://www.uspreventiveservicestaskforce.org/draftrec4.htm#arec.
The USPSTF recommends against screening for cervical cancer in women younger than age 21 years, regardless of sexual history. This is a D recommendation http://www.uspreventiveservicestaskforce.org/draftrec4.htm#drec.
The USPSTF recommends 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. This is a D recommendation http://www.uspreventiveservicestaskforce.org/draftrec4.htm#drec.
The USPSTF recommends against screening for cervical cancer in women who have had a total hysterectomy for benign disease. This is a D recommendation http://www.uspreventiveservicestaskforce.org/draftrec4.htm#drec.
The USPSTF recommends against screening for cervical cancer using human papillomavirus (HPV) testing, alone or in combination with cytology, in women younger than age 30 years. This is a D recommendation<http://www.uspreventiveservicestaskforce.org/draftrec4.htm#drec.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of HPV testing, alone or in combination with cytology, for screening for cervical cancer in women ages 30 years and older. This is an I statement http://www.uspreventiveservicestaskforce.org/draftrec4.htm#irec.
Liquid-Based Cytology : “A” recommendation
Liquid based cytology (LBC) is standard of care. Currently, about 95% of pap tests are done with liquid-based cytology. The USPSTF found “liquid-based cytology and conventional cytology had similar sensitivity and specificity for detecting cervical intraepithelial neoplasia.” This rating ensures that women who receive LBC will have access to Pap tests without co-pays.
HPV DNA co-testing I (insufficient evidence)
The USPSTF “I” grade for insufficient evidence is out of sync with the draft proposed recommendations published by the American Cancer Society, today. The ACS proposed recommendation is clearly in support of cotesing: Cotesting with cytology and HPV testing be utilized for general population screening in preference to the use of either test alone.
The FAQ from the ACS provides a helpful perspective regarding its position on co-testing.
Why are you recommending Pap plus HPV testing as the preferred strategy?
Studies show that HPV testing detects more cancers, more advanced precancers earlier, detects a second type of cervical cancer (called adenocarcinoma) that Pap tests usually miss, and provides added reassurance to women who test negative—safely allowing a much longer screening interval.
In fact, the American Cancer Society, the American College of Obstetrics and Gynecology, and other professional reproductive health organizations consistently support co-testing. The “I” grade is inconsistent with the recent work of the Institute of Medicine and the inclusion of HPV co-testing in HHS’ Guidelines on Preventive Services for Women. Those guidelines will require private insurance companies to cover HPV co-testing with no cost-sharing.
If this recommendation is not changed, women with private insurance will have coverage without cost-sharing for HPV co-testing; however, women on Medicaid, with coverage tied to USPSTF A and B recommendations will have to pay copays. In essence, women with the least will pay the most.
American Society for Colposcopy and Cervical Pathology (ASCCP), American Cancer Society (ACS), and American Society for Clinical Pathology draft cervical cancer screening recommendations address six areas:
In the next few weeks, we will be working with our colleagues in professional societies, women’s and reproductive health advocates, scientists and researchers to determine the most effective appropriate response. We will be developing a sign-on letter, and a web page with information about these important guidelines processes. We applaud these organizations for harmonizing the release of the guidelines in an effort to minimize the confusion in the field.
We look forward to working with you to advocate for the best possible screening guidelines to protect women from cervical cancer.
Warm regards,
Deborah and Fred
Deborah Arrindell
Vice President, Health Policy
American Social Health Association
debarrindell@aol.com
Fred Wyand, Director
HPV and Cervical Cancer Resource Center
American Social Health Association
fredwyand@ashastd.org