The American College of Physicians has released best practices to reduce unnecessary cervical cancer screening in average-risk women. The practices are endorsed by the American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology and have been published in the Annals of Internal Medicine.
Incidence and mortality for cervical cancer have decreased steadily, according to the study, published April 30. Decreases are attributed to widespread screening. However, medical cost for screening and follow-up in 2010 was estimated at $6.6 billion. In 2015, it is estimated that 12,900 U.S. women will be diagnosed with cervical cancer and 4,100 will die of the disease, the report stated. The current estimated incidence rate is 7.8 cases per 100,000 women per year.
Recent evidence-based guidelines for screening have refined the approach to minimize harms and maximize benefits, focusing on increasing the age at which to begin screening, lengthening the screening interval, and discontinuing screening in women at low risk for future cervical cancer. Overuse of screening contributes to higher healthcare costs without improving patient outcomes, researchers stated. They also noted screening more often than every three years increases harms of false-positive test results and invasive procedures, yet confers little benefit.
“Physicians and other healthcare providers can play a major role in reducing overuse of cervical cancer screening,” researchers said in the report. “They must first know current guidelines and should understand the reasoning behind the recommendation for less testing. The desire to find the right balance between benefits and harms should be familiar to all physicians steeped in a tradition of doing no harm.”
Recommended practices for screening based on systematic reviews and recent guidelines are: do not screen women under age 21, regardless of sexual history; screen with cervical cytology every three years beginning at age 21; use a combination of cytology and human papillomavirus testing every five years for women aged 30-65; no HPV testing for women before age 30; no screening beyond age 65 if patients had either three consecutive negative cytology tests or two negative cytology and HPV tests within 10 years (the most recent test must be within five years); and no screening for women who’ve undergone hysterectomy with cervix removal.
Average-risk women are those with no history of precancerous lesions or cervical cancer, who are not immunocompromised and were not exposed to diethylstilbestrol in utero.
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