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American Cancer Society News Update — Sept/Oct 2020

The American Cancer Society recently updated its guidelines for HPV vaccination. The primary message remains that HPV vaccination is cancer prevention but, instead of recommending vaccination “at 11 or 12, or as early as 9,” we’ve simplified that language to recommend HPV vaccination “between ages 9 and 12.”

A summary of ACS update:

New Cervical Cancer Screening Guidelines

We recommend screening begin at age 25 (no longer 21)

The updated guideline published today in our flagship journal, CA: A Cancer Journal for Clinicians, recommends that cervical cancer screening begin at age 25 and continue through age 65, for people at average risk, and that primary human papillomavirus (HPV) testing (without the Pap test) every 5 years be the preferred method of testing. Published along with the new guideline is a patient page.

Because these HPV tests may not be widely available in the U.S. yet, the guideline includes either of these two other acceptable screening methods and schedules:

The 2020 guidelines also recommend that people older than age 65 with a cervix stop being screened as long as they’ve had 10 years of regular screening with normal results. Otherwise, they should continue to be screened until they do. Cervical cancer screening may be discontinued in individuals of any age with limited life expectancy.

Those who have had their cervix removed, such as from a hysterectomy, don’t need screening as long as the surgery was done for reasons not related to cervical cancer or serious precancer. People who have gotten the HPV vaccine should still follow the screening guidelines as listed above.

In the U.S., the expectation is that over time fewer people will have a co-test or Pap test alone as the primary HPV test become more widely available. “When we combine improved HPV vaccination rates with the screening and treatment of precancers in the cervix, we have the potential to make history by eliminating cervical cancer,” said Debbie Saslow, PhD, a co-author of the 2020 ACS updated guideline.

The previous ACS guideline, released in 2012, called for screening starting at age 21. Since then, HPV vaccination rates have improved in the U.S. Data suggest vaccination has led to a drop-in rate of precancerous cervical changes, the precursors to cancer. Evidence shows the HPV test is more accurate than the Pap test and can be done less often; one HPV test every five years is more effective than a Pap test every three years, and even every year, as was recommended in the 1980s and 1990s.

Another reason for the change, is that cervical cancer incidence is low in the 20 to 24 age group. Cancer registry data from 2011 to 2015 indicates an estimated 108 cases of invasive cervical cancer in women 20 to 24 years in the U.S. each year, a number that is expected to continue to fall as vaccine use increases.

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