The American Society for Colposcopy and Cervical Pathology, the American Cancer Society, and the American Society for Clinical Pathology have released new guidelines for the prevention and early detection of cervical cancer.
The guidelines generally advise a reduction in the number of tests women get during their lifetime to ensure better that they receive the benefits of testing while minimizing the harms. They also include a preference for co-testing using the Pap test and HPV test for women from age 30 to 65.
The finalized updated guidelines recommend:
Women shouldn't be screened before age 21.
Women 21 to 29 should be screened with the Pap test alone (conventional or liquid-based) every three years. HPV testing shouldn't be used for screening in this age group.
For women 30 and over, the preferred approach is the Pap test plus HPV testing ("co-testing") every five years. Continued screening with the Pap test alone (without HPV testing) every three years is an acceptable alternative. While screening with HPV testing alone is promising, at this time, it isn't recommended for most clinical settings.
Screening isn't recommended for women over age 65 who have had at least three consecutive negative Pap tests or at least two negative HPV tests the last 10 years, with the most recent test in the last five years. Women in this age group who have a history of pre-cancer (CIN2 or a more severe diagnosis) should continue routine screening for at least 20 years.
Women who have undergone a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer or pre-cancer shouldn't be screened.
Women who have been vaccinated against HPV should follow the age-specific recommendations in these guidelines for unvaccinated women.
The new guidelines aren't intended for women with a history of cervical cancer, exposure to the diethylstilbestrol (DES) synthetic estrogen in utero, or women who are immunosuppressed (e.g. HIV positive). Costs and other financial issues weren't considered in creating the guidelines.
"While these new guidelines reflect relatively small changes over previous screening recommendations, they are important," says Dr. Alan Waxman, incoming president of the American Society for Colposcopy and Cervical Pathology. "The addition of HPV testing to the Pap test in women 30 and over has been shown in recent studies to provide better protection for longer intervals from cancer and pre-cancerous changes than the use of the Pap test alone."
The guidelines were scheduled to be presented at the ASCCP's biennial scientific meeting held in San Francisco in March. The information is available online at the ASCCP's Journal of Lower Genital Tract Disease website at www.jlgtd.com.
"Pap tests have been done yearly in the past, but we now know that annual screening is not needed and in fact can lead to harm from treatment of cell changes that would never go on to cause cancer," says Dr. Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society. "Since 1980, organizations, including the ACS, have recommended less frequent screening. With the addition of the HPV test, we can test even less frequently, as the risk of pre-cancer and cancer when both tests are negative is so low. With these recommendations, our groups are helping to make sure women get the full lifesaving benefits of screening while minimizing its known harms."
Other new recommendations included in the guideline:
Women at any age should NOT be screened annually by any screening method.
Women with a slightly abnormal Pap test result and a negative HPV test can be screened again with co-testing in 5 years or with the Pap test alone in 3 years.
Women with a negative Pap result but a positive HPV test can either be rescreened with co-testing in one year, or tested with a test for specific types of HPV (HPV 16 and HPV 18).
The updated guidelines were first released in draft form in late 2011. The working groups that created the draft guidelines then met with delegates from 25 organizations to discuss further and finalize the recommendations, which were then adapted into this final guideline.
"Our process resulted in guidelines that are focused on collectively presenting the best patient-centered cervical cancer screening strategies," says Dr. Mark Stoler, past president of the American Society for Clinical Pathology.
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Shirika la American Society for Colposcopy and Cervical Pathology, Shirika la American Cancer Society, na Shirika la American Society for Clinical Pathology zimetoa miongozo mipya ya kuzuia na kugundua mapema kansa ya shingo ya tumbo la uzazi. Miongozo hiyo inashauri kupunguza idadi ya vipimo ambavyo wanawake hupata katika maisha yao ili kuhakikisha wanapata faida za kupimwa na kupunguza madhara. Pia, ni muhimu kuzingatia kuwa mtihani wa Pap na mtihani wa HPV ni muhimu kwa wanawake wenye umri wa miaka 30 hadi 65. Miongozo ya hivi karibuni ya matibabu ya wanawake inashauriwa kuwa wanawake hawapaswi kupimwa kabla ya umri wa miaka 21. Wanawake wenye umri wa miaka 21 hadi 29 wanapaswa kuchunguzwa kwa mtihani wa Pap pekee (ya kawaida au ya kioevu) kila baada ya miaka mitatu. Utafiti wa HPV haupaswi kutumiwa kwa ajili ya uchunguzi katika kikundi hiki cha umri. Kwa wanawake wenye umri wa miaka 30 na zaidi, njia inayopendekezwa ni kufanya mtihani wa Pap na mtihani wa HPV kila baada ya miaka mitano. Uchunguzi wa kuendelea na mtihani wa Pap pekee (bila mtihani wa HPV) kila baada ya miaka mitatu ni mbadala unaokubalika. Ingawa uchunguzi wa HPV peke yake ni wa kuahidi, kwa sasa, haupendekezi kwa mazingira mengi ya kliniki. Utafiti wa HPV haupendekezi kwa wanawake wenye umri wa miaka 65 na zaidi ambao wamekuwa na angalau vipimo vya tatu vya Pap vya hasi au angalau vipimo viwili vya HPV vya hasi katika miaka 10 iliyopita, na mtihani wa hivi karibuni katika miaka mitano iliyopita. Wanawake katika kundi hili la umri ambao wana historia ya pre-cancer (CIN2 au utambuzi mbaya zaidi) wanapaswa kuendelea na uchunguzi wa kawaida kwa angalau miaka 20. Wanawake ambao wamepitia hysterectomy (na kuondolewa kwa shingo ya tumbo la uzazi) kwa sababu zisizohusiana na kansa ya shingo ya uzazi au kabla ya kansa haipaswi kuchunguzwa. Wanawake ambao wamepokea chanjo ya HPV wanapaswa kufuata mapendekezo maalum ya umri katika miongozo hii kwa wanawake ambao hawajapewa chanjo. Miongozo hiyo haikusudiwa kwa wanawake walio na historia ya saratani ya shingo ya tumbo la uzazi, kuambukizwa kwa estrojeni ya synthetic ya diethylstilbestrol (DES) katika tumbo la uzazi, au wanawake ambao ni immunosuppressed (kwa mfano, wanawake walio na ugonjwa wa kisukari). HIV-positive (HIV-positive) Gharama na masuala mengine ya kifedha hayakufikiriwa katika kuunda miongozo. "Hata kama miongozo hii mpya inaonyesha mabadiliko madogo kwa kulinganisha na mapendekezo ya awali ya uchunguzi, ni muhimu,"" anasema Daktari Alan Waxman, rais mpya wa American Society for Colposcopy and Cervical Pathology." "Utafiti wa hivi karibuni umeonyesha kwamba kuongeza vipimo vya HPV kwa vipimo vya Pap kwa wanawake wenye umri wa miaka 30 na zaidi hutoa ulinzi bora kwa vipindi virefu zaidi dhidi ya saratani na mabadiliko ya kabla ya saratani kuliko kutumia vipimo vya Pap peke yake. """ Miongozo hiyo ilipangwa kuwasilishwa katika mkutano wa kisayansi wa ASCCP uliofanyika San Francisco mwezi Machi. Habari hii inapatikana kwenye tovuti ya ASCP (Journal of Lower Genital Tract Disease) katika www.jlgtd.com. """Hata hivyo, uchunguzi wa Pap unafanywa kila mwaka, lakini sasa tunajua kwamba uchunguzi wa kila mwaka hauhitajiwi na kwa kweli unaweza kusababisha madhara kutokana na matibabu ya mabadiliko ya seli ambayo hayataendelea kusababisha kansa,"" anasema Debbie Sasslow, mkurugenzi wa saratani ya matiti na gynecological kwa American Cancer Society." Tangu mwaka wa 1980, mashirika ya afya, kutia ndani ACS, yamependekeza upimaji wa mara kwa mara. Kwa kuongeza mtihani wa HPV, tunaweza kupima mara chache zaidi, kwani hatari ya kabla ya saratani na saratani wakati vipimo vyote viwili ni hasi ni chini sana. """Kwa mapendekezo haya, makundi yetu yanasaidia kuhakikisha wanawake wanapata faida kamili za kuokoa maisha ya uchunguzi wa saratani wakati wa kupunguza madhara yake yanayojulikana." "Mapendekezo mengine mapya yaliyojumuishwa katika mwongozo huo ni kwamba ""wanawake wa umri wowote hawapaswi kuchunguzwa kila mwaka kwa njia yoyote ya uchunguzi.""" Wanawake wenye matokeo ya kawaida ya Pap na HPV ya hasi wanaweza kuchunguzwa tena na majaribio ya pamoja baada ya miaka mitano au na majaribio ya Pap pekee baada ya miaka mitatu. Wanawake ambao matokeo ya Pap ni hasi lakini mtihani wa HPV ni chanya wanaweza kuchunguzwa tena na kupimwa kwa mwaka mmoja au kupimwa kwa aina maalum za HPV (HPV 16 na HPV 18). Miongozo hiyo ilibadilishwa na kutolewa kwa mara ya kwanza mwishoni mwa mwaka 2011. Kikundi cha wafanyakazi kilichounda rasimu ya miongozo hiyo kilikutana na wajumbe kutoka mashirika 25 ili kujadili zaidi na kukamilisha mapendekezo, ambayo baadaye yalibadilishwa kuwa miongozo hii ya mwisho. "Mchakato wetu ulisababisha miongozo ambayo inazingatia kwa pamoja kuwasilisha mikakati bora ya uchunguzi wa saratani ya shingo ya tumbo la uzazi inayozingatia mgonjwa, ""anasema Dk Mark Stoller, rais wa zamani wa Jumuiya ya Amerika ya Patholojia ya Kliniki." Kujiandikisha leo kwa yetu bure E-Newsletter! KUJIJANDIKANYA