By Rebecca Bowers

According to the latest recommendations for cervical cancer screening from the US Preventive Services Task Force, all women 21 to 29 years of age should be tested every three years with cervical cytology. For women 30-65 years of age, recommendations call for Pap test screening alone every three years, high-risk human papillomavirus (hrHPV) test screening alone every five years, or screening using both tests every five years.1

Regular screening for women 21-65 years of age significantly lowers the rate of cervical cancer and the number of deaths resulting from the disease.2 A woman’s age will help determine the most effective screening test for her, according to the Task Force’s evidence search. Many HPV infections in women 21-29 years of age will resolve on their own; therefore, the Pap test is most effective in this age group.3 HPV infections in women 30-65 years of age are more likely to lead to cancer; in this group, either Pap tests or hrHPV tests are effective screening methods, according to the evidence review.4

However, new analysis suggests that the percentage of women who receive cervical cancer screening may be smaller than national data reflect.5 Less than 66% of women 30-65 years of age were current with their cervical cancer screenings in 2016. Just more than half of women 21-29 years of age had current screening during the same time period. Such numbers are lower than the screening compliance rate of 81% self-reported in the 2015 National Health Interview Survey.6

Such rates are “unacceptably low,” says the study’s lead author Kathy MacLaughlin, MD, a Mayo Clinic family medicine specialist. Screening routinely every three years using a Pap test or every five years using a Pap-hrHPV combination test makes sure that precancerous changes can be caught early so they can be monitored closely or treated, MacLaughlin said in a press statement.

Check the Numbers

To perform the analysis, Mayo Clinic researchers reviewed medical records using the Rochester Epidemiology Project, a records-linkage research project offering population-based medical research in Olmsted County, MN. By using the database, researchers were able to determine the cervical cancer screening rates for more than 47,000 women who were living in the county from 2005 to 2016. Investigators calculated three-year (Pap) and five-year (Pap-hrHPV) prevalence screening rates in proportion to eligible population, and used multivariable logistic regression to assess factors potentially associated with screening.

Statistics indicate that in 2016, 64.6% of 27,418 eligible women 30-65 years of age were current with cervical cancer screening, with 60.8% of them reporting Pap-HPV co-test screening. However, researchers observed significant declines in Pap completion rates over time in all age groups. Although Pap screening rates decreased, Pap-hrHPV cotesting significantly increased among women ages 30-65, rising from 10.0% in 2007 to 60.8% in 2016.5

Are All Women Being Reached?

The researchers reported that disparities by race, ethnicity, smoking status, and comorbidity level were observed among the current study’s population, with African-American women 50% less likely to be current with cervical cancer screening than white women. Asian women were almost 30% less likely than white women to have up-to-date screening, they noted.5

Healthcare providers should consider new ways to reach patients and make sure they receive screening, says MacLaughlin. Options to expand access could include Pap clinics with appointments available in the evenings and on Saturdays, or availability of cervical cancer screenings at urgent care clinics, she notes. For women who are appropriate candidates for primary HPV screening, clinics also could explore the possibility of providing patients with kits for at-home testing. Recent research indicates that self-collected swabs are effective and may lead to increased access to testing.7-8

“We, as clinicians, must start thinking outside the box on how best to reach these women and ensure they are receiving these effective and potentially life-saving screening tests,” noted MacLaughlin.

REFERENCES

  1. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA 2018;320:674-686.
  2. Safaeian M, Solomon D, Castle PE. Cervical cancer prevention — cervical screening: Science in evolution. Obstet Gynecol Clin North Am 2007;34:739-760.
  3. Kotaniemi-Talonen L, Anttila A, Malila N, et al. Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3. Eur J Cancer 2008;44:565-571.
  4. Melnikow J, Henderson JT, Burda BU, et al. Screening for cervical cancer with high-risk human papillomavirus testing: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018;320:687-705.
  5. MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, et al. Trends over time in Pap and Pap-HPV cotesting for cervical cancer screening. J Womens Health (Larchmt) 2019; doi: 10.1089/jwh.2018.7380. [Epub ahead of print].
  6. Watson M, Benard V, King J, et al. National assessment of HPV and Pap tests: Changes in cervical cancer screening, National Health Interview Survey. Prev Med 2017;100:243-247.
  7. Catarino R, Vassilakos P, Bilancioni A, et al. Accuracy of self-collected vaginal dry swabs using the Xpert human papillomavirus assay. PLoS One 2017;12:e0181905.
  8. Porras C, Hildesheim A, González P, et al; CVT Vaccine Group. Performance of self-collected cervical samples in screening for future precancer using human papillomavirus DNA testing. J Natl Cancer Inst 2014;107:400.