Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Screening for Cervical Cancer in Primary Care

JAMA; 2018 Aug 21; Kim, Burger, et al

Primary high-risk human papillomavirus (hrHPV) screening may represent a reasonable balance of harms and benefits when performed every 5 years, according to a recent microsimulation modeling study. Researchers sought to inform the US Preventive Services Task Force (USPSTF) by modeling the benefits and harms of various cervical cancer screening strategies in a cohort of women initiating screening at aged 21 years. Exposures included screening with cytology, hrHPV testing, and cytology and hrHPV cotesting, varying age to switch from cytology to hrHPV testing or cotesting (25, 27, 30 years), rescreening interval (3.5 years), and triage options for hrHPV-positive results. They found:

  • Compared with no screening, all modeled cervical cancer strategies were estimated to result in substantial reductions in cancer cases and deaths and gains in life-years.
  • Screening across the different strategies showed similar effectiveness, with primary hrHPV-based and alternative cotesting strategies having slightly higher effectiveness and greater harms than current guidelines-based cytology testing.
  • In all analyses, 5-year primary hrHPV testing strategies occurring at 5-year intervals were efficient.
  • Switching from cytology to hrHPV testing at age 30 yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms.

Citation:

Kim JJ, Burger EA, Regan C, Sy S. Screening for cervical cancer in primary care. A decision analysis for the US Preventive Services Task Force. JAMA. 2018;320(7):706–714. doi:10.1001/jama.2017.19872.

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