Do Women Still Need 2 Tests For Cervical Cancer? : Shots
A proposal to simplify cervical cancer screening could end up missing some cancers, researchers and patient advocates say. And that could be especially true for minority women.
Latina and black women already have the highest rates of cervical cancer in the U.S., and more than half of women diagnosed with the disease were not screened in the 5 years before their diagnosis, according to the Centers for Disease Control and Prevention.
In September, the influential U.S. Preventive Services Task Force issued draft recommendations for women ages 30 to 64, saying they could either get a Pap smear every three years or a human papillomavirus (HPV) test every five years. (The USPSTF did not recommend changes for any other ages.) That’s a change from the task force’s 2012 guidelines, which recommended co-testing with both the HPV and Pap tests every five years. And that’s what two dozen other medical organizations still recommend.
They include the American Cancer Society, the American College of Physicians and the American Congress of Obstetricians and Gynecologists (ACOG). In response to the USPSTF draft recommendations, ACOG and the American Society for Colposcopy and Cervical Pathology (ASCCP) issued a joint statement reaffirming their support for co-testing every five years, or screening with a Pap alone every three years.
In 2014, a total of 12,578 US women were diagnosed with cervical cancer and 4,115 died, according to the CDC. But those numbers obscure demographic disparities.
“We are concerned about the women who basically will fall through the cracks if co-testing does not continue to be recommended and therefore reimbursed” by insurance companies, says Carolyn R. Aldigé, the president and founder of the Prevent Cancer Foundation, who wrote an op-ed supporting continued use of co-testing. “We’re particularly concerned about medically underserved women who have less access to screening in general and higher rates of cervical cancer.”
The USPSTF has extended the deadline for comments on the proposed change until Friday, Oct., 13 at 8 pm ET. They can be filed online.
According to CDC data, Latina women have the highest rate of cervical cancer in the U.S. Black women have the second highest cancer rate, but are more likely than Latina women to die of the disease. Limiting access to screening, especially for these groups, is “the wrong direction to go in,” Aldigé says.
In a statement to the USPSTF from the National Latina Institute for Reproductive Health, Ann Marie Benitez, the organization’s senior director of governmental affairs and a cervical cancer survivor, pointed out the systemic barriers Latina women face in getting adequate preventive care and the research that supports co-testing.
“The largest retrospective study of cervical cancer screening strategies found that 1 out of 5 cases of cervical cancer was missed with primary HPV screening alone,” Benitez’s statement reads. “The USPSTF recommendations for screening must be revised to address the reality that many women at higher risk would be missed with less frequent and less comprehensive screening. Changes in this policy would put the lives of women of color further at risk.”
The USPSTF relied on seven randomized controlled trials and five observational studies for their decision. Six of the randomized controlled trials were European — from England, Finland, the Netherlands, Sweden and two from the same group in Italy — and one was Canadian. Most of these countries have predominantly white populations, and only the Canadian study reported participants’ race or ethnicity. The USPSTF also noted their evidence review had no trials that directly compared HPV testing alone vs. co-testing. Yet their draft recommendations include HPV testing alone as a screening option, something no other medical organizations currently recommend.
The trials’ testing methods also differ from tests used in the U.S. standard of care, according to Dr. Harvey Kaufman, medical director at Quest Diagnostics, a large medical testing company. Neither of the two HPV tests used in the studies is the one approved for primary HPV testing in the U.S., he says, and five of the seven studies used different types of Pap tests.
“Virtually every woman in the U.S. gets liquid-based cytology, which is much more sensitive and has different performance characteristics,” Kaufman says. Liquid-based cytology and conventional Pap cytology are both ways to analyze cervical cells; evidence is mixed on how they differ. “So they end up with a core base of literature that doesn’t apply to the U.S.,” he says.