Do I need to be screened for cervical cancer under 25?
2020-09-08
A few days ago, the American Cancer Society (ACS) released the latest cervical cancer screening guidelines in its flagship magazine "CA: Clinicians' Cancer Journal", calling for the reduction and simplification of screening. Now organize it for you as follows:
The new ACS guidelines recommend:
Women start cervical cancer screening at the age of 25 and continue until the age of 65. The first choice is to test for human papillomavirus (HPV) every 5 years.
If there is no condition for primary HPV testing, women aged 25-65 should have a Pap smear and HPV test (combined test) every 5 years or a separate Pap smear every 3 years.
The guidelines point out that combined testing or separate Pap test is listed as an option for cervical cancer screening because not all laboratories currently have the ability to detect primary HPV. Once the transition is completed, future guidelines will no longer recommend the use of Pap smear cytology testing alone or combined testing to screen for cervical cancer.
Those who are older than 65 years old, have no history of CIN2+ in the past 25 years, and have a negative cervical cancer screening record 10 years before the age of 65 (2 consecutive primary HPV tests were negative in the past 10 years, or 2 combined tests were negative, or 3 times Pap smear cytology is negative, and the last test was completed within the past five years), all forms of cervical cancer screening can be stopped.
If there are insufficient records to prove that the previous screening meets the criteria for stopping screening, women who are older than 65 years old and have no diseases that affect life expectancy should continue to be screened until they meet the criteria for stopping screening.
Women with limited life expectancy, regardless of age, can stop cervical cancer screening.
"These simplified recommendations can improve compliance and reduce potential harm." said Dr. Debbie Saslow, managing director of the HPV and GYN cancer divisions of the American Cancer Society. Methods of screening."
Almost all cases of cervical cancer are caused by persistent high-risk HPV infection. There is evidence that HPV testing is more accurate than Pap test and can reduce the frequency of screening. An HPV test every five years is more effective than a Pap smear test every three years (or even every year). Those who have a negative HPV test have a very low risk of cervical cancer.
In addition, the HPV vaccine has been used for many years, and now more and more women of the right age choose to be vaccinated, which can prevent most cervical cancers.
The ACS guidelines issued in 2012 require women to be screened for cervical cancer at the age of 21. But since then, the HPV vaccination rate in the United States has increased. Data show that vaccination has led to a continuous decline in the rate of cervical precancerous lesions.
However, considering the following three factors, ACS has postponed the recommended screening age to 25 years:
The incidence of cervical cancer is lower in the age group under 25. Cancer registry data from 2011 to 2015 show that in the United States, there are an estimated 108 cases of invasive cervical cancer in women between 20 and 24 years old each year. With the increase in vaccination rates, this number is expected to continue to decline;
Precancerous lesions detected by treatment are potentially harmful, and there is no evidence that screening can reduce the incidence of cancer in women in this age group;
In women of this age, most HPV infections cannot be detected within 1-2 years.
Dr. Saslow said: "We estimate that compared with the current recommended strategy of cytology (Pap smear) screening from 21 years old and combined screening from 30 years old, the primary HPV test is started from 25 years old. It will prevent 13% more cervical cancer and 7% more cervical cancer-related deaths. Our research shows that this goal can be achieved by increasing the follow-up by 9%, but the overall required examinations have been reduced by 45%."
