HPV testing preferred over Pap for cervical cancer screening starting at age 30, task force’s draft recommendation says

Testing for high-risk human papillomaviruses every five years – even with a self-collected sample – is the “preferred screening strategy” for cervical cancer starting at age 30, according to a new draft recommendation from the US Preventive Services Task Force.

Traditionally, many women have been screened for cervical cancer with cervical cytology – also known as Pap tests or Pap smears – in which cells from the cervix are collected and checked for signs of cancer.

But the draft USPSTF recommendation, released Tuesday, emphasizes testing for high-risk human papillomaviruses, or HPV, as a primary screening approach for women ages 30 to 65, as most cervical cancers are caused by the virus. The HPV test involves collecting a vaginal sample and checking cells for infection with the high-risk types of HPV that can cause cervical cancer.

“We are highlighting that HPV screening, as the primary screening for women ages 30 to 65, is the best balance between the benefits and the harms in finding cervical cancer, and that should be offered first and when available,” said task force member Dr. Esa Davis, professor and senior associate dean for population health and community medicine at the University of Maryland in Baltimore.

And for the first time, the draft recommendation statement includes the option for women to self-collect their own vaginal samples for HPV testing.

“Now we have an additional screening test that may be more appealing to those who otherwise would not come in for screening, and that’s with self-collection,” Davis said.

When HPV testing is not available, then it is recommended to perform a Pap test for screening, or co-test with both HPV testing and cervical cytology.

HPV testing “has the best balance of benefits and harms, but the other two are effective screening options as well, and so therefore they’ll still be a choice for clinicians and for patients,” Davis said.

This update in the draft recommendation is not because a Pap test is harmful, but because an HPV test is more effective as a cervical cancer screening tool for ages 30 to 65, according to the task force. The draft recommendation continues to recommend screening with cervical cytology alone every three years for women in their 20s.

The draft recommendation is not final, but will be available on the task force’s website for public comment through January 13, along with a draft evidence review, according to USPSTF, a group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans.

The American Cancer Society also recommends HPV testing as part of a cervical cancer screening plan, and on its website, the organization states that a primary HPV test is better at preventing cervical cancers than a Pap test that is performed alone.

“We look forward to reviewing these important guideline recommendations for cervical cancer screening and providing feedback to the USPSTF,” Dr. Robert Smith, senior vice president, early cancer detection science at the American Cancer Society, said in a statement. “Screening guidelines are critically important to women as cervical cancer is one of the most preventable and treatable types of cancer, and it is essential that women get screened regularly.”

‘Early detection is really important’

It’s estimated that about 80% of people will get an HPV infection in their lifetime.

HPV, a group of more than 150 viruses, is spread primarily through sexual contact and includes low-risk strains, which most often cause warts, and high-risk strains, which have been associated with an increased risk of certain cancers, such as cervical, anal, penile and oropharyngeal cancers.

If a woman is found to have high-risk HPV, it does not necessarily mean she has cancer. In most cases, HPV clears on its own within two years, but when the infection does not go away, health problems like cancer may occur – which is why detecting these infections early can be helpful so that it can be monitored.

When finalized, the draft recommendation will update the USPSTF’s latest cervical cancer screening recommendation, which was issued in 2018. That year, the task force recommended to screen for the disease every three years with cervical cytology alone in women ages 21 to 29. For women ages 30 to 65, it recommended three options: continue screening every three years with cervical cytology alone; every five years with high-risk human papillomavirus testing alone; or every five years with high-risk HPV testing in combination with cytology.

The task force recommended against screening for cervical cancer in women younger than 21, and in women older than 65 who have had adequate prior screenings and are not otherwise at high risk for cervical cancer – and the new draft recommendation statement continues that guidance.

Overall, “it is really, really important to get screened if you’re in that age range of 21 to 65 regularly, because cervical cancer is very preventable and treatable, and early detection is really important,” Davis said, adding that the introduction of self-collection HPV tests in the new draft recommendation may help to expand access to screening.

Self-collection for HPV testing

In May, the US Food and Drug Administration expanded the approvals of two HPV tests to allow for self-collected vaginal samples to be used with those tests when a patient either cannot or prefers not to have the sample collected by a health care professional.

With this greenlight from the FDA, patients now have the option to collect their own vaginal samples for screening if the self-collection occurs in a health care setting, such as at their doctor’s office, an urgent care or even a mobile clinic. The approach is similar to how patients may self-collect a urine sample when they visit their doctor.

“This self-collection option does provide more access to women who just may feel more comfortable doing those self-collections and thus, expands the opportunity to screen more women who may not have come in for screening otherwise,” Davis said.

“For women who were not coming in before because they felt uncomfortable, here’s an option now that hopefully will appeal to that group and get them in for screening, because cervical cancer is preventable if detected early,” she said. “We wouldn’t want any barriers for women who are eligible to be screened.”