The updated American Cancer Society cervical cancer screening guideline introduces 2 major changes: the option for patients to self-collect vaginal specimens for human papillomavirus testing and revised criteria for safely discontinuing screening. Investigators reported that polymerase chain reaction–based assays using self-collected samples demonstrated sensitivity ranging from 76% to 100% for detecting cervical intraepithelial neoplasia grade 2 or worse, and concordance between self-collected and clinician-collected samples frequently exceeded 88%. Regulatory trial data showed comparable accuracy between methods, including equivalent 92.8% sensitivity for identifying high-grade lesions with the Roche cobas test and 90.3% sensitivity for detecting cervical intraepithelial neoplasia grade 2 or worse with the BD Onclarity assay. These findings support self-collection as a reliable screening option for average-risk patients.
The American Cancer Society (ACS) released the updated guideline, published in CA: A Cancer Journal for Clinicians, to improve screening uptake and reduce cervical cancer mortality in the US. Robert A. Smith PhD, of the Center for Early Cancer Detection at ACS in Atlanta, Georgia, noted that the recommendations “will help to improve compliance with screening and reduce the risk of cervical cancer," according to a ACS press release. The ACS Guideline Development Group evaluated evidence from meta-analyses, national screening programs, and regulatory studies that involved more than 150,000 self-collected samples. The group used a formal endorsement process, including a methodological review using the Appraisal of Guidelines for Research and Evaluation II instrument and a targeted literature search. After reviewing recommendations from the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee, the group endorsed self-collection for average-risk patients aged 25 to 65 years. Clinician-collected cervical specimens remain the preferred method because they permit cytology or dual-stain testing without requiring an additional visit after a positive human papillomavirus (HPV) result.
The guideline recommends repeat screening in 3 years for patients with a negative self-collected test, reflecting limited long-term US data on risk following a negative result regarding screening every 5 years after age 25 as the preferred strategy per guideline updates in 2012 and 2020. The update also simplifies exit criteria by recommending 2 negative HPV tests or co-tests at ages 60 and 65, or 3 consecutive negative cytology tests when HPV testing is unavailable. These changes address evidence that shows only 1 in 3 women aged 64 to 66 currently meet exit criteria and that 1 in 4 cervical cancers occurs after age 65. “Our goal with this guideline revision is to further expand and simplify cervical cancer screening in the United States to move toward our goal of the elimination of cervical cancer as a public health problem,” noted the guideline's lead author Rebecca B. Perkins MD, of the Tufts University School of Medicine/Tufts Medical Center in Boston, Massachusetts, with colleagues.
The guideline authors also address concerns with demand capacity and collection tool availability, as well as exclusions for high-risk populations. The SHIP trial, which is currently underway with the National Cancer Institute, is "expected to provide robust, US-based evidence on the performance of unsupervised, at-home self-collection and will inform future guideline recommendations for primary HPV-based cervical cancer screening," they wrote.
Several contributors reported external research funding, consulting relationships, or stock ownership unrelated to the guideline, while two are employed by the ACS, and all other authors reported no conflicts of interest.
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