New cervical cancer screening guidelines
Shifting from overscreening young women to minimize harms
December 20, 2016
A new Cervical Cancer Screening in Canada report published by the Canadian Partnership Against Cancer shows more than half of Canadian women aged 18 to 20 years had at least one Pap test between January 2010 to June 2013. New guidelines released in 2013 no longer recommend screening for women in this age group.
Cervical cancer screening in young women may detect some abnormalities, but about 90% of low-grade cervical abnormalities in young women regress within three years and only 3% progress to high-grade disease. These abnormal results can lead to needless anxiety, unnecessary tests, and, in some cases, treatments that could potentially cause adverse outcomes.
The report found that 49 to 90% of Canadian women (depending on the province or territory) aged 18 to 20 had at least one Pap test from January 2010 to June 2013 which includes the five month period after the national guidelines changed in January 2013. The estimated cost of these Pap tests and the associated treatment was about $58 million per year. The cost of providing and processing the Pap test to women aged 18 to 20 was nearly $14 million. The cost of their follow-up treatments was almost $44 million.
“Canadian women deserve the right care at the right time, but the evidence is clear: young women do not benefit from early Pap testing,” said Kathleen Decker, Expert Lead for Cervical Cancer at the Partnership and Chair of the Pan-Canadian Cervical Cancer Screening Network. Continuing to screen in this age group has risks for young women and comes at great cost to the health system.
The report includes information about screening coverage, follow-up, the quality of screening, pre-cancer and cancer detection, and disease extent at diagnosis for women 21 to 69 years of age for the years 2011 to 2013.
All provinces and territories recommend that cervical cancer screening start at age 21, continue until age 65 to 70, and occur every two to three years. In 2013, the Canadian Task Force on Preventive Health Care updated its guidelines and now recommends routine screening every three years for women starting at age 25 and ceasing at age 69 for those who have been adequately screened.
However, the report found that 37% of women diagnosed with squamous cell carcinoma and 30% of women diagnosed with non-squamous cell carcinoma had their last Pap test more than five years before their diagnosis, or had no record of a Pap test at all. In addition, up to 30% of eligible women were not screened for cervical cancer.
With appropriate screening, the number of women who are diagnosed with invasive cervical cancer – estimated 1,500 Canadian women in 2016 – could be drastically reduced.