Cervical Cancer Screening Saves Lives!
Help Protect Women’s Health and Ensure Continued Access to Comprehensive Cervical Cancer Screening
Each year, approximately 12,000 women are diagnosed with cervical cancer.1 While all women are at risk, women over the age of 30 are especially vulnerable to this disease. However, with regular screening, cervical cancer is the easiest type of gynecologic cancer to prevent and, when discovered early, is one of the most curable cancers.2
Cervical Cancer Screening Today
Women can be screened for cervical cancer in several different ways: A Pap test, an HPV test and, most commonly, a combination of the two known as co-testing.
A Pap test is used to find cell changes or abnormal cells in the cervix (these abnormal cells may be pre-cancer or cancer, but they may also be other things, too). Cells are lightly scraped or brushed off the cervix. They are sent to a lab and looked at under a microscope to see if the cells are normal or if changes can be seen. The Pap test is a very good test for finding cancer cells and cells that might become cancer.3
The HPV test checks for the human papillomavirus virus, a virus that can cause cell changes in the cervix.3
Co-testing involves getting an HPV test along with the Pap test at the same time. Co-testing is the preferred way to find early cervical cancers or pre-cancers in women 30 and older. Evidence-based guidelines developed by the American College of Obstetricians and Gynecologists (ACOG), the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology (ASCP), and the American Cancer Society support co-testing as the current standard of care.4-7
Why NPWH Recommends Co-Testing (Pap and HPV tests combined)
We believe co-testing is the most effective strategy for early disease detection.
Large peer-reviewed published studies in the United States indicate that co-testing identifies significantly more cervical pre-cancer and cancer than either test used alone.8,9
Co-testing has been shown to identify 94.5% of all cervical cancers.10
Recent data also support the enhanced benefits of co-testing every three years.10,11 Most clinicians and nurse practitioners today recommend co-testing every three years for patients.12,13
New Draft Guidelines Put Women’s Lives at Risk
In September 2017, the U.S. Preventive Services Task Force (USPSTF) released draft recommendations for cervical cancer screening that recommended single testing for women between 30-65 but did not include co-testing.14 As the largest group of nurse practitioners dedicated to women’s health in the United States, we disagree with this proposal. Here’s why:
More Cancers Missed
In our clinical experience, we know co-testing saves lives. The data cited above confirms the value of co-testing too. Without access to co-testing, more cancers would be missed that could have been detected and treated earlier.
Concerns about the Analysis/Modeling
The draft guidelines relied on studies mostly conducted outside the United States that lacked the diversity seen in U.S. women. European cervical cancer screening programs are different than those in the United States, and their studies do not adequately reflect U.S. demographics, making them less effective in determining American guidelines. The Task Force also reviewed studies that used non-FDA-approved technology to make its recommendations and selected evidence that benefited single-test screening.
Impact on Health Insurance Coverage
If these draft recommendations are accepted, health plans may no longer include co-testing as a preventive health care benefit available to women. If co-testing is not covered by health insurance, the likelihood of women seeking out or authorizing their practitioners to conduct these routine screenings for cervical cancer could drop significantly.
Leading Experts Support Co-Testing
“A Pap test plus an HPV test (called co-testing) is the preferred way to find early cervical cancers or pre-cancers in women 30 and older.”
– ACS, January 2018
“We urge the USPSTF to retain 5-year co-testing as a screening option for women aged 30-65 years…we are deeply concerned that payers may consequently deny coverage for co-testing, which remains the preferred method in our guidelines and is supported by Level 1 evidence demonstrating its efficacy for cervical cancer prevention.”
– ACOG, October 9, 2017 USPSTF Comments
“The CETC is concerned that if Primary HPV screening every 5 years is endorsed by the USPSTF, without co-testing as a screening option, this change may potentially impact safety and efficacy for cervical cancer prevention in the United States... Women in general are not interested in assuming more cancer risk.”
– Cytopathology Education and Technology Consortium (CETC), October 2, 2017 USPSTF Comments
“By not including co-testing, women over the age of 30 would be limited to either a Pap test or an HPV test. This is a significant departure from established current clinical practice and could not only risk reversing nearly 75 years of advances against cervical cancer diagnoses and deaths, but also widen the racial disparity gap for cervical cancer.”
– Black Women’s Health Imperative, October 9, 2017 The Hill Op Ed
“This curtailment of comprehensive screening for cervical cancer could have a devastating impact on women’s health care, while also putting the progress we’ve made on saving lives through screening in peril. Limitations on cervical cancer co-testing must be reconsidered.”
– Prevent Cancer Foundation, October 6, 2017, US News and World Report Op Ed
NPWH statements of support for effective screening and testing
Rep. DeLauro Remarks
Remarks by Representative Rosa DeLauro on Cervical Cancer Prevention.
Frequently asked questions about the USPSTF
Key Facts and Figures: Cervical Cancer Screening Today
Concerned? Here’s How You Can Help
NPWH issued a statement expressing our apprehension about the removal of co-testing in USPSTF draft guidelines. View our statements of support for effective screening and testing here.
We encourage you to reach out to your Members of Congress and urge them to act.
Look up your members of Congress here
Access tips for calling Congress
Contact your members of Congress directly, or call 202-224-3121 and ask to be connected to their office
Share your perspective on why co-testing is vital to your patients and explain that women in [district/city/state] and across the United States deserve access to the standard of care that is recommended by clinical and cancer prevention organizations including the NPWH, the American Cancer Society, the American College of Obstetricians and Gynecologists and other leading groups. If you reach a voicemail, be sure to leave a message and remind them that you are a constituent.
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