Evidence Favors Cytology, Not HPV Screening, for Cervical CA

And, screening for cervical cancer should start at age 21 years and end at 65 years

MONDAY, Oct. 17 (HealthDay News) -- Evidence favors the use of liquid-based cytology (LBC) or conventional cytology rather than human papillomavirus (HPV) screening for cervical cancer; and cervical cancer screening should begin at age 21 years and end at age 65 years, according to two reviews published online Oct. 17 in the Annals of Internal Medicine.

Evelyn P. Whitlock, M.D., M.P.H., from Kaiser Permanente Northwest in Portland, Ore., and colleagues reviewed the available literature from 2000 through 2011 to collect fair to good quality evidence comparing LBC or HPV primary screening with conventional cytology for cervical intraepithelial neoplasia (CIN) and cervical cancer detection. LBC had sensitivity and specificity equivalent to conventional cytology. One-time HPV screening was more sensitive but less specific than cytology for detecting CIN3+/CIN2+. For women older than 30 years, primary HPV screening detected more CIN grade 3 or cancers, and co-testing (HPV plus cytology) showed mixed results.

Kimberly K. Vesco, M.D., M.P.H., also from Kaiser Permanente Northwest in Portland, Ore., and colleagues determined the appropriate age to begin and end cervical cancer screening based on epidemiologic and contextual data. The investigators suggest that cervical cancer screening should begin at 21 years, as women younger than 20 years rarely have cervical cancer, and screening was associated with lower detection rates, high false-positive results, and potential adverse effects. Evidence supports discontinuation of screening for women aged 65 or older if they have had adequate screening, and are not deemed at high risk.

"The available evidence suggests that cervical cancer screening should not begin before 21 years of age," Vesco and colleagues write.

Abstract - Whitlock
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Abstract - Vesco
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