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Cited by 1,409Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement

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US Preventive Services Task Force, Curry, Susan J., Krist, Alex H., Owens, Douglas K., Barry, Michael J., Caughey, Aaron B., Davidson, Karina W., Doubeni, Chyke A. +10 more·2018·JAMA
DOI 10.1001/jama.2018.10897
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Abstract

Importance: The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015. Objective: To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer. Evidence Review: The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies. Findings: Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit. Conclusions and Recommendation: The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer. (D recommendation).

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  • USPSTF and ACOG recommend that cervical cancer screening begin at age 21 years.

    “Guidelines from USPSTF and ACOG recommend that cervical cancer screening begin at age 21 years (174,175).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [174]

  • All screening programs rely on cancer risk models, which predict who is likely to develop cancer at a future point in time.

    “To achieve this goal, all screening programs rely on cancer risk models, which predict who is likely to develop cancer at a future point in time.”

    From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [97]

    The sections on Benefits and Harms of Various Screening Strategies Based on Decision Modeling and Screening Interval Based on Decision Modeling describe models used to compare cervical-screening strategies and intervals. Our copy does not say that all screening programs rely on models that predict an individual's future cancer risk; searches for individual risk prediction found no such passage. The indexed passages provide no page numbers. (LLM, conf=0.75)

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  • Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness.

    “Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care (i.e., first visit during the second trimester or later) or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness (174,633–636).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [174]

    The Treatments and Interventions section identifies risk factors for cervical cancer, not syphilis during pregnancy. Searches for the claimed syphilis risk factors, including prenatal care, drug use, incarceration, and homelessness, found no passage addressing them in our copy. The available passages have no page numbers. (LLM, conf=0.78)

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Research works printed but not linked: 2

  1. Vesco KK, Whitlock EP, Eder M, et al. Screening for Cervical Cancer: A Systematic Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No. 86. Rockville, MD: Agency for Healthcare Research and Quality; 2011. AHRQ publication 11-05156-EF-1.
  2. Naucler P, Ryd W, Törnberg S, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer [published correction appears in N Engl J Med. 2008;359(15):1637].

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Authors
US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B.
Affiliations
  • University of Iowa (US)
  • Virginia Commonwealth University (US)
  • Harvard University (US)
  • Oregon Health & Science University (US)
  • Columbia University (US)
  • Carilion Clinic (US)
  • Nationwide Children's Hospital (US)
  • University of Alabama at Birmingham (US)
  • University of California, Los Angeles (US)
  • Boston University (US)
  • Northwestern University (US)
  • University of Hawaiʻi at Mānoa (US)
  • Tufts University (US)
Corresponding author
Curry, Susan J.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-08-21
Volume
320
Issue
7
Pages
674
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.10897
OpenAlex
W2909340392
Cited by
1,409
References
62
Citations by year
2026: 140 · 2025: 201 · 2024: 196 · 2023: 187 · 2022: 188 · 2021: 189 · 2020: 156 · 2019: 105 · 2018: 24 · 2017: 17 · 2016: 4 · 2012: 2
FWCI
92.15
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer screening, high-risk human papillomavirus testing, cervical cytology, screening frequency, screening age thresholds, hysterectomy, cervical cancer mortality, screening harms, net benefit, decision-analytic model, USPSTF recommendations, cervical precancerous lesions
MeSH terms
Adult, Aged, Uterine Cervical Neoplasms, Cervix Uteri, Female, Humans, Mass Screening, Middle Aged, Vaginal Smears, Papillomaviridae, Early Detection of Cancer, Young Adult

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