Cervical cancer guidelines analysis focuses on balancing prevention and cost concerns


Over the years, a number of authoritative sources have issued various guidelines regarding cervical cancer screening. Even though all of the guidelines are based on the evidence, they vary in their ultimate recommendations and can be difficult to coordinate and apply to practice.

A recent Perspective article in the New England Journal of Medicine compared guidelines from the American College of Obstetricians and Gynecologists (ACOG) (2009); the U.S. Preventive Services Task Force (USPSTF) (2011 draft); and the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] the American Society for Clinical Pathology (ASCP) (2011 draft).

Key Point: Look to consensus amongst various cervical cancer screening guidelines when creating screening programs for patients. Using evidence-based medicine will result in high-quality prevention while also managing cost considerations.

The analysis focused on identifying common ground between the recommendations to help physicians maintain high-quality cervical cancer prevention protocols that also safely incorporate cost considerations.

Cervical cancer ranks as the most frequent cancer among women in India, and the most frequent cancer among women 15 to 44 years old. According to a 2010 report by the WHO/ICO Information Centre on HPV [human papillomavirus] and Cervical Cancer (http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/IND.pdf), 134,420 women in India are diagnosed with cervical cancer each year, and 72,825 die from the disease.

The NEJM analysis found identical or similar recommendations between the 3 sets of guidelines in the following areas:

  • Age to start cervical cancer screening: 21 years (recommended by all of the guidelines)
  • Testing frequency (Pap testing alone) for women 21 to 29 years: every 3 years (ACS-ASCCP-ASCP and USPSTF) or every 2 years (ACOG)
  • Testing frequency (Pap testing alone) for women 30 years and older: every 3 years (recommended by all)
  • Testing frequency (Pap and HPV co-testing) for women 30 years and older: recommended but no more frequently than every 3 years (ACS-ASCCP-ASCP); allowed but no more frequently than every 3 years (ACOG); insufficient data to recommend (USPSTF)
  • Age to stop cervical cancer screening: 65 years after 3 negative Pap tests or 2 negative HPV tests in the past 3 years (ACS-ASCCP-ASCP); 65 to 70 years after 3 negative tests in the preceding 10 years (ACOG); 65 years after adequate screening (USPSTF)
  • After hysterectomy: discontinue if no dysplasia or cancer (recommended by all)
  • Screening after HPV vaccination: same as when unvaccinated (ACS-ASCCP-ASCP and ACOG); not addressed (USPSTF)

The analysis points out that although experts are often best suited to issue guidelines based on their analysis of the evidence-based clinical data, various panels may interpret data differently and emphasize different results in making their recommendations. She emphasized the importance of making guidelines easier to understand in order to enhance patient outcomes while also minimizing costs for unnecessary referrals and treatment. The author added: “…Even with the best consensus guidelines, some clinical judgment and personalized attention to each patient remains necessary.”

Source: Feldman, S. Making sense of the new cervical-cancer screening guidelines [Perspective]. NEJM. 2011;365(23):2145-2147.

Access the original journal information here:
http://www.nejm.org/doi/full/10.1056/NEJMp1112532
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

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This entry was posted in Ob/Gyn, Oncology, Primary Care, Women's Health and tagged , , , , , , . Volume: .

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