U PREVENTIVE SERVICES TASK FORCE ...

U PREVENTIVE SERVICES TASK FORCE

This is undivided in a series excerpted from the Recommendations and Rationale Statements released by dint of the current U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary-care clinical settings, including screening examples counseling, and chemoprevention. The clean statement is available in HTML and PDF formats end the AFP Web site at www.aafp. org/afp/20030415/us. html This statement is part of AFP's CME descry "Clinical Quiz" on page 1663

This statement summarizes the rife U.S. Preventive Services Task Force (USPSTF) recommendations forward screening for cervical cancer and the supporting scientific evidence. They update the 1996 recommendations contained in the Guide to Clinical Preventive Services, secondary edition. (1) Explanations of the ratings and of the nerve of overall evidence are given in Tables 1 and 2 respectively. The unimpaired information on which this statement is based, including evidence tables and allusions is available in the systematic evidence review, "Screening for Cervical Cancer," (2) which is available in succession the USPSTF Web site (www.preventiveservices.ahrq.gov) and within the National Guideline Clearinghouse (www.guideline.gov). The recommendation statement is also available in print in consequence of the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295; e-mail: ahrqpubs@ahrq.gov).

Summary of Recommendations

* The USPSTF vehemently recommends screening for cervical cancer in women who have been sexually active and have a cervix. A recommendation.

The USPSTF set good evidence from multiple observational studies that screening with cervical cytology (eg Papanicolaou [Pap] smears) makes incidence of and mortality from cervical cancer. Direct evidence to determine the optimal starting and stopping age and the interval for screening is limited. Indirect evidence refer tos that most of the benefit can be obtained according to beginning screening within three years of attack of sexual activity or age 21 (whichever be due [i]or[/i] owings first) and screening at least each three years (see Clinical Considerations). The USPSTF bring to an ends that the benefits of screening substantially outweigh potential harms.

* The USPSTF attract favor tos against routinely screening women older than age 65 for cervical cancer if they have had adequate latter screening with normal Pap smears and are not otherwise at high risk for cervical cancer (see Clinical Considerations). D recommendation.

The USPSTF erect limited evidence to determine the benefits of continued screening in women older than 65 The yield of screening is depressed in previously screened women older than 65 to be paid to the declining incidence of high-grade cervical lesions after middle age. There is fair evidence that screening women older than 65 is associated with an increased risk for potential harms, including false-positive accrues and invasive procedures. The USPSTF deduces that the potential harms of screening are likely to exce benefits among older women who have had normal follows previously and who are not otherwise at high risk for cervical cancer.

* The USPSTF commends against routine Pap smear screening in women who have had a total hysterectomy for benign disease. D recommendation.

The USPSTF establish fair evidence that the yield of cytologic screening is self-same low in women after hysterectomy and poor evidence that screening to discover vaginal cancer improves health consequences The USPSTF concludes that potential harms of continued screening after hysterectomy are likely to exce benefits.

* The USPSTF judges that the evidence is insufficient to commit for or against the routine use of novel technologies to screen for cervical cancer. I recommendation.

The USPSTF fix poor evidence to determine whether modern technologies, such as liquid-based cytology, computerized rescreening, and algorithm-based screening, are more effective than conventional Pap smear screening in reducing incidence of or mortality from invasive cervical cancer. Evidence to determine the couple sensitivity and specificity of strange screening technologies is limited. As a outcome the USPSTF concludes that it cannot determine whether the potential benefits of recent screening devices relative to conventional Pap ordeals are sufficient to justify a possible increase in potential harms or costs

* The USPSTF ends that the evidence is insufficient to attract favor to for or against the routine use of human papillomavirus (HPV) testing as a primary screening exhibition for cervical cancer. I recommendation.

The USPSTF set poor evidence to determine the benefits and potential harms of HPV screening as an adjunct or alternative to regular Pap smear screening. Trials are underway that should betimes clarify the role of HPV testing in cervical cancer screening.

Clinical Considerations

* The goal of cytologic screening is to sample the transformation climate the area where physiologic transformation from columnar endocervical epithelium to squamous (ectocervical) epithelium takes place and where dysplasia and cancer arise. A meta-analysis of randomized trials supports the combined use of an extended-tip spatula to sample the ectocervix and a cytobrush to sample the endocervix. (3)