NCCN updates NCCN Clinical Practice Guidelines in Oncology for Cervical Cancer Screening

The National Comprehensive Cancer Network (NCCN) recently made updates to the NCCN Clinical Practice Guidelines in Oncology(TM) for Cervical Cancer Screening that include a new section providing recommendations for women who have positive results for the HPV High Risk DNA test but negative cervical cytology screen/Pap smears.

Cervical cytology screening, either conventional Pap smears or liquid-based cytology, is the current method for early detection of cervical cancer. The FDA recently approved two new diagnostic HPV DNA tests. An updated version of the HPV High Risk (HR) DNA test determines whether any of the 14 oncogenic (i.e., high-risk) types of HPV are present, but it does not indicate which types are present. The HPV 16/18 DNA test determines whether HPV-16, HPV-18, or both are present. These types are responsible for an estimated 70 percent of cervical cancer.

The new section in the updated NCCN Guidelines provides guidance for women 30 years and older who receive a positive result using the HPV HR DNA test but have a negative cervical cytology/Pap smear. Their options may include either 1) have the more specific HPV 16/18 DNA test, or 2) proceed directly to colposcopy. A colposcopy, where the cervix is viewed through a long focal-length microscope, is the primary method for evaluating women with abnormal cervical cytologies.

At the present time, the NCCN Cervical Cancer Guidelines recommend that HPV DNA testing should complement cervical cancer screening methods, such as regular Pap smears and gynecologic examinations, not replace these methods. However, the NCCN Guidelines note that HPV DNA testing is not recommended in women younger than 21 years of age.

The NCCN Guidelines also provide screening recommendations for women who have received the HPV vaccine. The HPV vaccine, which is approved by the FDA for girls and women ages 9 to 26 years old, provides protection against four types of HPV (types 6, 11, 16, 18). The NCCN Guidelines stress that vaccinated women remain at risk for less common types of HPV and should continue to be screened.

The current NCCN Guidelines recommend that women should begin screening for cervical cancer approximately three years after the onset of vaginal intercourse or no later than 21 years of age.

Despite a significant decrease in the incidence and mortality of cervical cancer in the United States, it is estimated that 11,270 women will be diagnosed in 2009.