What should you know about cervical cancer testing?

This Scientific Short is part of a series on Academy Guidance Documents. To view the full document click here.

Recently, the Academy of Diagnostics and Laboratory Medicine (formerly AACC academy) published AACC Guidance Document on Cervical Cancer Detection: Screening, Surveillance, and Diagnosis (1). This guidance document introduces currently available cervical cancer screening tests, testing strategies, and the most recently updated screening guidelines as well as risk-based management guidelines. In addition, a report template for HPV and cervical cancer detection is proposed to facilitate interpretation of testing results and clinical decision-making.

It is well known that persistent genital infection with high-risk human papilloma virus (hrHPV) causes most cases of cervical cancer. Early screening, ongoing surveillance, and accurate diagnosis are crucial for the elimination of cervical cancer. New screening guidelines for testing in asymptomatic healthy populations and guidelines for managing abnormal results have been published by professional organizations (2-4).

Currently available cervical cancer screening tests include hrHPV testing and cervical cytology screening. The screening strategies can be primary HPV screening, co-testing with HPV testing and cervical cytology, and cervical cytology alone. Although these strategies are recommended in both 2018 US Preventive Services Task Force (USPSTF) (2) and 2020 American Cancer Society (ACS) (3) guidelines, the age to start screening and frequency of screening are different in these guidelines. For example, USPSTF-recommended age to start screening is 21 years old and screening should be repeated every 3 years by cytology alone from age 21 to 65, or every 5 years by cytology plus HPV testing or by HPV testing alone from age 30 to 65 (2). However, ACS recommends that screening should start at age 25 and repeat every 5 years if HPV testing alone or cytology plus HPV testing strategy is used, or every 3 years if cytology testing alone (3). Both USPSTF and ACS agree that screening should end at age 65 for women with all prior normal results and no symptoms (2,3). For those with prior abnormal results and/or symptoms, the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) guideline (4) should be followed.

To use the 2019 ASCCP risk-based management guidelines, clinicians should estimate an individual’s risk of CIN 3+ based on current and prior cytology, HPV, and pathology data as well as personal factors such as age and immunosuppression status. The personal risk score determines management. According to the risk, the patient may return every 1, 3 or 5 years for surveillance if the risk is <4%. However, if the risk is high (≥4%), the patient may receive colposcopy examination or expedited treatment.

To implement these guidelines, the AACC guidance document proposes an ideal laboratory report template, which includes the indication for the test (screening, surveillance, or diagnostic workup of symptomatic patients); type of test (primary HPV screening, co-testing, or cytology alone); clinical history of the patient; and prior as well as current testing results (1).

Finally, the AACC guidance document discusses a potential new approach in cervical cancer screening, which is the use of self-collected vaginal specimens for genotyping of HPV; however, self- sampling is not yet FDA-approved and is not currently the standard of care in the United States. More studies are needed to determine the performance of self-collected vaginal specimens for genotyping of HPV.

References

1. Zhu Y, Feldman S, Leung SOA, Creer H, Warrick J, Williams N, Mastorides S. AACC Guidance Document on Cervical Cancer Detection: Screening, Surveillance, and Diagnosis. J Appl Lab Med 2023;8(2):382-40
2. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA 2018;320:674–86.
3. Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin 2020;70: 321–46.
4. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:102–31.