Individual Screening: Cervical Cancer

Cervical cancer is a significant public health concern worldwide, affecting millions of women annually. In the United States, it ranks among the leading causes of cancer-related deaths in women, despite being highly preventable and treatable using various strategies. Screening plays a pivotal role in identifying precancerous lesions and early-stage cervical cancers, thus enabling timely intervention and reducing mortality rates (Zhang et al., 2020). The U.S. Preventive Services Task Force (USPSTF) provides evidence-based guidelines for cervical cancer screening, aiming to improve outcomes for those at risk of cervical cancer. This discussion focuses on the epidemiology of cervical cancer and evidence-based recommendations from the USPSTF.

Condition and Screening

The identified condition for this discussion is cervical cancer and the type of screening is one recommended by the USPSTF. Cervical cancer represents abnormal growth of cells in the cervix that is primarily linked to high-risk strains of the human papillomavirus (HPV) (Oyola & VanGompel, 2020). HPV infections in the cervix proceed to precancerous lesions and then invasive cancer if left untreated. Cervical cancer screening is an approach that aims to identify the precancerous changes during early stages to enable interventions before disease progression. There are various types of screening available to help in identifying this disease including pap tests, HPV DNA and RNA tests, and visual inspection using various solutions. USPSTF recommends cervical cancer screening using two methods which include a Pap test and high-risk human papillomavirus (hrHPV) testing (Oyola & VanGompel, 2020). These interventions are based on evidence and they are dependent on factors like age and availability of resources.

Epidemiology of Condition

Cervical cancer refers to cancer that starts in the cervix when normal cells of the cervix first gradually develop abnormal changes. The American Cancer Society describes the changes using three key terms that include cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia (Oyola & VanGompel, 2020). Although most women will have these characteristics, some with these changes develop cancer. The incidence rate of cervical cancer in the US is approximately 7.2 per 100,000 women annually (Zhang et al., 2020). Recent data shows that about 13,820 new cases of the disease are recorded annually. The mortality rate of cervical cancer has decreased since the implementation of widespread cancer screening from 2.8 to 2.3 deaths per 100,000 women. Recent data shows that about 4360 women die from cervical cancer annually compared to large numbers in the previous years.

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Age-specific rates are another key aspect of cervical cancer epidemiology that guides screening and implementation of preventive services. According to the American Cancer Society, the disease is most frequently diagnosed in women aged 35 to 44 years with the average age being 50 years (Basoya & Anjankar, 2022). Although the disease affects about 20% of women aged 65 years and above, it rarely occurs in those who have been getting regular screening. Despite overall improvements, disparities in cervical cancer incidence and mortality persist. Higher rates are reported among Black and Hispanic women compared to White women (Zhang et al., 2020). The death rate among Black women and Native American women is about 65% higher than in White women. The disease rarely develops in adolescents and rates have recently declined in those aged 20 to 24 years because of HPV vaccination.

Methodology

The methodology of USPSTF guideline development follows a rigorous evidence-based approach. The development of the cervical cancer screening guidelines followed a review of screening evidence focusing on clinical trials and cohort studies (USPSTF, 2018). The studies focused on screening using hrHPV and cytology testing in comparison with other methods. To evaluate the age at which to begin screening, the task force commissioned a decision analysis model. The model considered aspects like age of screening, optimal screening interval, effectiveness of the strategies, and risk-benefit analysis.

The population for screening is divided into three categories. The task force describes screening among women aged 21 to 29 years every 3 years. The second category involves women aged 30 to 65 years who are considered to be at the greatest risk of the disease (Basoya & Anjankar, 2022). The third category includes ages that do not require screening and this includes women younger than 21 years and those older than 65 years who have had adequate screening. In addition, women who have had a total abdominal hysterectomy do not require screening. Based on the guideline methodology, two risk factors addressed include age and sexual activity. For example, screening is not recommended for women below 20 years old because the group is not considered sexually active compared to other age groups (Basoya & Anjankar, 2022). Transient HPV infections are more common in those aged 21 to 29 years and negative screening until the age of 65 years renders most women safe from the disease.

Guideline

The most current recommendation involves screening for cervical cancer every 3 years with a Pap test for women aged 21 to 29 years (USPSTF, 2018). Secondly, those aged 30 to 65 years should receive Pap tests every 3 years and hrHPV screening every five years (USPSTF, 2018). The guidelines prohibit screening for women aged 21 years and below, those who have had a total abdominal hysterectomy, and women above 65 years whose subsequent screening has shown normal results.

Critical Analysis

Cervical cancer screening plays a key role in comprehensive prevention and control besides HPV vaccination. Screening for cervical cancer mainly uses the Pap test method and liquid-based cytology (LBC) using acetic acid & Lugol’s iodine solutions. The sensitivity of these tests has been studied and comparisons made to ensure the right measures are taken to prevent cervical cancer. It is shown that cytology has a sensitivity as high as 80 to 90% (Zhang et al., 2020). Another key aspect that should be considered is the efficacy of co-testing for cervical cancer using Pap test and hrHPV.

Previous recommendations stated that women aged 30 to 65 years should receive a cytology test every three years and hrHPV every 5 years or co-testing. However, changes have been made based on the evidence that hrHPV testing alone and co-testing approaches prevented a similar number of cancer cases (Oyola & VanGompel, 2020). Although these recommendations are clear, screening alone is not a solution to cervical cancer. Other strategies like creating equitable access to follow-up of abnormal results and providing appropriate treatment should be adopted (Basoya & Anjankar, 2022). Although this disease threatens the health of women, it can be the first type of cancer to be effectively controlled and eliminated using appropriate strategies.

In conclusion, the USPSTF recommends cervical cancer screening for women starting at the age of 21 years. The task force recommends Pap test screening for those aged 21 to 29 years every 3 years. For those aged 30 to 65 years, the taskforce recommends a Pap test every 3 years, hrHPV testing every 5 years, or co-testing. Routine screening is not recommended for individuals aged below 21 years and those older than 65 years who have had adequate prior screening and are not at high risk for cervical cancer. Generally, testing for cervical cancer is beneficial because it ensures early detection and prevention through the treatment of pre-cancerous lesions to prevent invasive cervical cancer. Screening is also important because early detection improves clinical outcomes including survival rates and improved quality of life.

References

Basoya, S., & Anjankar, A. (2022). Cervical cancer: Early detection and prevention in reproductive age group. Cureus, 14(11), e31312.

https://doi.org/10.7759/cureus.31312

Oyola, S., & VanGompel, E. W. (2020). PURL: USPSTF expands options for cervical cancer screening. The Journal of family practice, 69(6), E7–E9.

U.S. Preventive Services Task Force. (2018). Cervical cancer: screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening

Zhang, S., Xu, H., Zhang, L., & Qiao, Y. (2020). Cervical cancer: Epidemiology, risk factors and screening. Chinese journal of cancer research = Chung-kuo yen cheng yen chiu, 32(6), 720–728. https://doi.org/10.21147/j.issn.1000-9604.2020.06.05