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A new large-scale study published in the Annals of Internal Medicine (November 2017) suggests that it may be safe to extend cervical cancer screening intervals to five years or more for women who have received negative results from combined HPV and cytology testing. The analysis followed nearly one million women — 990,013 subjects — who underwent combined screening between 2003 and 2014, tracking how cervical cancer risk changed with each consecutive round of negative test results.
The findings showed that the risk of invasive cervical cancer and CIN3 lesions decreased with each round of combined negative testing, with the most significant risk reduction occurring between the first and second rounds. Women who tested negative on their first HPV test had a 5-year invasive cervical cancer risk reduction of 0.0092%, dropping further to 0.0015% after a third consecutive negative result. These numbers indicate that the cumulative protective effect of repeated negative results is substantial, lending support to longer intervals between screenings for low-risk women.
Cervical cancer screening guidelines have been evolving, particularly in the context of widespread HPV vaccination. The 2015 ACOG guidelines recommend HPV testing as an alternative screening method for women over 25, with cytology every three years or combined cytology and HPV testing as the preferred approach. The USPSTF draft guideline, however, recommends testing only for high-risk HPV subtypes as an alternative to simple cytology for women over 30, and no longer recommends combined testing.
Researchers commenting on the study noted that in the first round of combined testing, women with negative HPV results alone had only a slightly higher cancer risk than those with negative combined results. After a second negative HPV result, the risk difference became negligible, and after a third, it essentially disappeared. The analysis also found that combined testing offered only minimal advantages over HPV-only testing in detecting CIN3 lesions, while adding unnecessary colposcopy, biopsy, and potential overtreatment. Taken together, the evidence increasingly supports HPV testing as a reliable, sufficient tool for extended screening intervals in women with consistently negative results.
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About Sai Sree
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