The Case For Cervical Cancer Co-Testing

In 2018, it is estimated that more than 13,000 women will be diagnosed with cervical cancer, most often with a pap smear, also called a pap test, or a pap smear combined with a screening test for HPV, human papillomavirus. At one point, cervical cancer was one of the most common causes of cancer death for women in the U.S.

Over the last four decades, however, mortality rates have been reduced by more than half, and that drop is largely attributed to the effectiveness of pap tests. In fact, advances in cervical cancer screening, including co-testing with a pap smear and HPV screening, have caused the greatest success stories in healthcare. That’s because, if cervical cancer is found early it is one of the most treatable forms of cancer.

Still, every year, more than 4,000 women die from cervical cancer.

Now, a troubling development in the form of recently proposed new guidelines for cervical cancer screening, could endanger the health and lives of women by reducing the availability of these diagnostic tools.

Currently, the medical guidelines, which were established in 2012, call for women between the ages of 30 and 65 to be co-tested with both a pap smear and HPV screening every five years. These guidelines, and specifically the use of both tests, have proven critical to saving lives by diagnosing cervical cancer as early as possible, leading to more successful treatments.

Under the proposed new guidelines, which were released in September of last year by the U.S. Preventive Services Task Force, women between the ages of 21 and 65 would be given only a pap smear every three years, while women between 30 and 65 would be screened by pap tests every three years, or tested for high-risk HPV every five years. Most notably, these recommendations do not prescribe any form of co-testing.

Why this is a bad idea

Shortly after the recommendations were announced, several prominent medical organizations responded opposing the new guidelines, including the American Cancer Society, the American Congress of Obstetricians and Gynecologists and the American College of Physicians. The American Society of Colposcopy and Cervical Pathology, in collaboration with the ACOG, released a joint statement from the presidents of both organizations that reaffirmed their full support for the existing guidelines.

I strongly advocate for keeping the guidelines that include co-testing in place for several important reasons:

• The guidelines often determine what health insurance covers. If the proposed guidelines are finalized, health plans will not be required to cover co-testing as they do now.
• The current guidelines save lives. The key to treating cervical cancer, as with most cancers, is early detection. It is possible that if cervical cancer screening guidelines are cut back, some patients will slip through the cracks and their cancers will not be diagnosed until it’s too late for successful treatment.
• Cervical cancer may be missed more often. In a large retrospective study, researchers found that one out of every five cases of cervical cancer was missed when HPV screening was used without a Pap test.
• Women of color will be affected more than the population at large. According to the U.S. Centers for Disease Control and Prevention, African-American and Hispanic women are most likely to be affected by cervical cancer. In fact, African-American women are dying from cervical cancer at the highest rate among all populations.

It is my hope that the voices opposing these guideline changes will grow louder and eventually be loud enough to convince the task force to reverse its position.