Tuesday, September 12, 2017

USPSTF Releases New Draft Cervical Screening Recommendations; Comment til October 9

On September 12, 2017, USPSTF released new draft recommendations for cervical cancer screening tests.   In the draft, "co-testing" (joint PAP and HPV virus testing) has been removed as a recommended strategy.   Stakeholders can comment until October 9.   See the USPSTF webpage here.  See coverage at Medscape here and at Genomeweb here.  NPR here and MedpageToday here.

USPSTF recommendations can be quirky regarding lab testing.   The colon cancer screening recommendations (2016) basically recommend a wide range of methods with the emphasis that patients get one of them - get some form of colon cancer screening.  The BRCA preventive testing recommendation is light on specifics of the genetic testing method (2013) -- whole sequencing, founder mutations, use of dup-del analysis (and of what form) -- these are left to the discretion of the reader, as long as patients get some form of BRCA testing.

In a "net benefits" section, USPSTF acknowledged that cervical preps, HPV, and co-testing with both cervical cytology and HPV were all effective strategies.  USPSTF asserts that "modeling suggests that both HPV testing alone and cotesting offer similar benefit over cytology..."   This will likely draw substantial comment from the lab community.

Medicare covers cervical cancer testing through a separate, statute and NCD based process.  It has covered cotesting since 2015 (CMS press here, NCD here, coding here).  It is covered only to age 65, mapping to the older USPSTF recommendation.  Medicare law covers Pap smears at 12 to 24 months, based on risk factors.  The addition of HPV benefits, by NCD, did not change the coverage of Pap benefits, in statute, but was layered on top of them rather than revising them.

A few interesting comments from the USPSTF draft discussion include these:
     Unlike cytology, samples for HPV testing have the potential to be collected by the patient and mailed to health programs for analysis, meaning self-collection may be one strategy for increasing screening rates among populations where they are currently low. [But] Rigorous comparative studies are needed to verify this hypothesis and to identify effective strategies for implementation.
     Another important area for future research is the effect of HPV vaccination, as an increasing number of women and men of screening age are being vaccinated. Decreases in HPV type prevalence due to vaccination could reduce the positive predictive value of HPV testing....
A copy of the September 2017 draft report is archived in the cloud (as PDF and as Word).