Task Force says annual screening for asymptomatic women is unnecessary
Ottawa, 7 January, 2013–The Canadian Task Force on Preventive Health Care (Task Force) today released an updated guideline on cervical cancer screening, recommending women aged 25–69 years be screened at an interval of three years. The CTFPHC, an independent body of fourteen specialists with expertise in prevention, and primary care in Canada, says early and frequent (often annual) cervical screening is unnecessary. The guideline is published in the Canadian Medical Association Journal.
The guideline is an update to that last published by the CTFPHC in 1994 and is based on the best and latest evidence in cervical cancer screening. Aimed at physicians, policy makers and Canadian women, the updated guideline identifies the optimal use and frequency of screening (Pap tests) for cervical cancer in asymptomatic women who are or who have been sexually active, regardless of sexual orientation
“Since the introduction of Pap tests in Canada, the proportion of women getting cervical cancer has declined from 1.5% of all women to 0.66%, and the proportion dying from cervical cancer had declined from 0.94% to 0.22%” said Dr. James Dickinson, member of the CTFPHC and chair of the guideline working group. “And while it is likely that most of this improvement is a result of screening, other countries have achieved similar outcomes despite initiating screening at an older age and implementing longer screening intervals. Reducing the number of pap tests gives women the benefit from screening, while reducing the inconvenience, discomfort and potential harms caused by early and excessive testing.”
The current guideline differs from the previous 1994 CTFPHC recommendations in a number of ways:
- The updated guideline says routine screening is not recommended in sexually active women who are younger than 25. The 1994 guideline recommended annual screening with Pap tests after initiation of sexual activity or at age 18.
- The updated guideline recommends asymptomatic women aged 25–69 (who are or have been sexually active) be screened at an interval of 3 years. The 1994 guideline recommended women aged 20–69 be screened every three years—but only after 2 normal Pap tests.
- In the updated guideline, screening is now explicitly recommended in women older than 69, if prior screening has not been adequately performed. In the previous guideline, screening women aged 70+ was not recommended.
“The greatest reduction in cervical cancer will be achieved by screening more eligible women who have not previously been screened, and not by screening more women earlier or more often,” according to the authors of the guideline. “Identifying the optimal use and frequency of screening will help reduce the inconvenience, discomfort and potential harms caused by early and excessive testing, while still ensuring the greatest benefit from screening.”
The main recommendations of the guideline include:
- The CTFPHC recommends against cervical cancer screening (with Pap tests) for women aged younger than 25 because minimal or no benefit was found to outweigh the potential harms in this group.
- The CTFPHC found moderate quality evidence showing that screening with Pap tests may have a small effect in reducing cervical cancer mortality and morbidity among women aged 25–29 and recommends screening these women at intervals of 3 years.
- The CTFPHC found high quality evidence showing that screening for cervical cancer with Pap tests reduces mortality and morbidity among women aged 30–69, and strongly recommends screening these women at intervals of 3 years.
- Screening may cease in women aged 70 and older, but only after 3 successive negative Pap tests.
For the complete report and details of the recommendations, please visit the cervical cancer screening guideline.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.