The American Cancer Society (ACS) is introducing two key changes for cervical cancer screening: the option of self-collection of vaginal samples for primary human papillomavirus (HPV) testing, (although clinician-collected cervical samples are still preferred), and new guidance on when women can safely stop being screened for cervical cancer.
The update is published in a report in CA: A Cancer Journal for Clinicians, the flagship journal of ACS, reports The Washington Post.
Experts say the updated recommendations reflect advancements in disease detection and access to screening options in the United States.
Self-collection could be transformative for increasing screening, said Jane Montealegre, an associate Professor in the Department of Behavioural Sciences at the University of Texas MD Anderson Cancer Centre.
What the guidelines say
Every year, about 13 000 new cases of cervical cancer are diagnosed in the US –and about 4 000 women die, according to the Centres for Disease Control and Prevention.
While the ACS notes that screening programmes have been successful at dramatically decreasing incidence by more than half since the mid-1970s, data shows that these rates have declined in the past 20 years.
“The updated recommendations are made possible as we transform our approach to screening for cervical cancer, primarily through research advancements and the development of self-collection tools to make sure everyone who needs screening is able to access it,” said Robert Smith, ACS senior vice-president of Early Cancer Detection Science.
A self-collected test could be a good option for people who aren’t comfortable getting a pelvic exam or don’t have access to one, Montealegre said.
“A lot of women have many insurmountable barriers to coming in to see their provider for screening,” she added, “and this is a way towards double screening participation for those people who haven’t been able to do so previously.”
Under the ACS guidelines, average-risk people should start screening at 25 years old. When clinician-collected cervical samples are used for HPV testing, repeat screening is recommended every five years for those with a negative test. Self-collected vaginal swabs should be tested every three years.
If testing for just HPV is not available, the ACS recommends women aged 25 to 65 should be screened with a combination of an HPV test and a Pap smear every five years, or just a Pap smear every three years.
The updated guidelines also say many women with a recent history of consecutively negative tests can stop testing at 65.
“The changes are significant, as now patients have another cancer screening option, alongside colon cancer screening, that they can do at home or a location of their choosing,” said Arif Kamal, ACS Chief Patient Officer.
How self collection works
Because at-home screening tools are still limited, a self-collected vaginal swab is typically done in a clinical setting, such as during a visit to the primary care physician or family doctor.
In May, the FDA approved the first at-home screening tool to detect cervical cancer: a wand developed by Teal Health that allows patients to self-collect a vaginal sample and mail it to a lab for testing.
The rollout of self-collection options for cervical cancer screening has been slow, Montealegre said, but she noted that the new ACS guidelines could drive uptake.
“When you have ACS provide guidelines that clearly say self-collection is possible, it’s good, and this is not an inferior screening test, I think it really gives that reassurance to everybody,” she said.
Having access to these tests doesn’t mean you should stop seeing your doctor, with Kamal saying about 5% to 10% of HPV tests are positive and require follow-up with a clinician.
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HPV vaccine cuts cervical cancer by nearly 90% — UK population registry study
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Do regular cancer screenings extend life?
Cancer screening – the good, the bad and the ugly