The US Preventive Services Task Force (USPSTF) has issued a new draft recommendation that proposes testing for high-risk human papillomaviruses (HPV) every five years as the "preferred screening strategy" for cervical cancer prevention, starting at the age of 30. This approach challenges the traditional method of cervical cytology, known as Pap tests or Pap smears, which involves examining cells from the cervix for signs of cancer. The draft recommendation, released on Tuesday, underscores the importance of HPV testing as the primary screening method for women aged 30 to 65, given that the majority of cervical cancers are linked to the HPV virus.

The HPV test involves taking a vaginal sample to detect the presence of high-risk HPV strains that are known to cause cervical cancer. Dr. Esa Davis, a task force member and senior associate dean for population health and community medicine at the University of Maryland in Baltimore, stated, "We are emphasizing that HPV screening, as the primary screening for women aged 30 to 65, offers the best balance of benefits and risks in detecting cervical cancer, and should be offered first and when available."

For the first time, the draft recommendation also includes the option for women to self-collect their vaginal samples for HPV testing. Dr. Davis explained, "Now we have an additional screening test that may be more appealing to those who would not otherwise come in for screening, and that’s with self-collection." This new option could encourage more women to get screened, particularly those who may feel uncomfortable with the traditional method.

In cases where HPV testing is not accessible, the recommendation is to perform a Pap test or a co-test that includes both HPV testing and cervical cytology. Dr. Davis noted, "HPV testing offers the best balance of benefits and risks, but the other two are also effective screening options, and thus they will remain a choice for clinicians and patients." The update in the draft recommendation is not due to any harm caused by Pap tests, but rather because HPV testing is deemed more effective for cervical cancer screening in women aged 30 to 65.

The draft recommendation maintains the advice to screen with cervical cytology alone every three years for women in their 20s. It is not final and will be open for public comment on the task force’s website until January 13, along with a draft evidence review. The USPSTF, a group of independent medical experts, issues recommendations that guide medical decisions and influence insurance plans.

The American Cancer Society also endorses HPV testing as part of a cervical cancer screening plan, stating on its website that a primary HPV test is more effective at preventing cervical cancers than a standalone Pap test. Dr. Robert Smith, senior vice president for early cancer detection science at the American Cancer Society, said in a statement, "We look forward to reviewing these important guideline recommendations for cervical cancer screening and providing feedback to the USPSTF." He emphasized the critical importance of screening guidelines for women, as cervical cancer is one of the most preventable and treatable types of cancer, and regular screening is essential.

It is estimated that approximately 80% of people will contract an HPV infection at some point in their lives. HPV is a group of over 150 viruses, primarily spread through sexual contact, which includes low-risk strains that often cause warts and high-risk strains that are associated with an increased risk of certain cancers, such as cervical, anal, penile, and oropharyngeal cancers. Detecting high-risk HPV does not necessarily indicate cancer; in most instances, HPV clears on its own within two years. However, when the infection persists, it can lead to health issues like cancer, which is why early detection is crucial for monitoring and prevention.

Once finalized, the draft recommendation will update the USPSTF’s latest cervical cancer screening recommendation from 2018. At that time, the task force advised screening every three years with cervical cytology alone for women aged 21 to 29. For women aged 30 to 65, they recommended three options: continue screening every three years with cervical cytology alone; every five years with high-risk HPV testing alone; or every five years with high-risk HPV testing combined with cytology. The task force advised against screening for cervical cancer in women under 21 and in women over 65 who have had adequate prior screenings and are not at high risk for cervical cancer, guidance that the new draft recommendation continues to reflect.

Dr. Davis emphasized the importance of regular screening for cervical cancer for those aged 21 to 65, stating, "Cervical cancer is very preventable and treatable, and early detection is crucial." The introduction of self-collection HPV tests in the new draft recommendation may help to increase access to screening. In May, the US Food and Drug Administration expanded the approvals for two HPV tests to allow for the use of self-collected vaginal samples when a patient cannot or prefers not to have the sample collected by a healthcare professional. With this approval, patients now have the option to collect their own vaginal samples for screening in a healthcare setting, such as at their doctor’s office, an urgent care center, or even a mobile clinic, similar to how patients may self-collect a urine sample during a doctor’s visit.

Dr. Davis further explained, "This self-collection option does provide more access to women who may feel more comfortable doing those self-collections and thus, expands the opportunity to screen more women who may not have come in for screening otherwise. For women who were not coming in before because they felt uncomfortable, here’s an option now that hopefully will appeal to that group and get them in for screening, because cervical cancer is preventable if detected early. We wouldn’t want any barriers for women who are eligible to be screened."