The biggest change is a recommendation to start screening for cervical cancer at age 25 instead of 21. One reason: vaccination rates have improved.
If left undiagnosed, HPV can cause more problems for women, leading to precancerous changes in the cervix.As of 2018, 39.9% of adults ages 18 to 26 reported having received at least one dose of the three-dose HPV vaccine schedule. 51.1% of men and 68.1% of women ages 13 to 17 had at least one dose of the vaccine. The authors of the guidelines wrote that they expect the HPV vaccine"to have a substantial impact on cervical cancer screening strategies and outcomes in coming years.
Certified medical assistant Karla Huerta fills a needle with the drug Gardasil, used for HPV vaccinations, at Amistad Community Health Center in Corpus Christi, Texas, on Friday, May 27, 2016. The guidelines also recommend doctors start testing for HPV infection at age 25, and every five years thereafter. This is a big change, as the guidelines previously stated testing should start at age 30.
HPV and Pap tests are often performed together because they both entail a pelvic exam. With a Pap test, cells are observed under a microscope to detect abnormal changes, but an HPV test looks for the presence of the virus itself.There has been a debate in the medical community about which of the three ways is best for screening. Many believe that cotesting is better at catching cancer than HPV testing alone.
This undated microscope image provided by the NewYork-Presbyterian/Columbia University Irving Medical Center in October 2018 shows squamous cell carcinoma of the cervix, the most common form of cervical cancer. "It's the responsibility of the practitioner to discuss the latest guideline updates to help patients understand why that's changed and then let the patient decide for themselves, with autonomy, how they would like to proceed," Dr. Shepherd said.
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