Updated NCCN Guidelines for Cervical Cancer Screening Highlight Appropriate Use of New HPV DNA Tests
The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Guidelines for Cervical Cancer Screening to provide further recommendations for a subset of women with conflicting results on cervical cytology/Pap tests and Human papillomavirus (HPV) High Risk DNA tests. The NCCN Guidelines include recommendations regarding screening techniques, screening intervals, and management of abnormal screening resulting from cervical cytology/Pap smear and colposcopy.
October 14, 2009
FORT WASHINGTON, PA — The National Comprehensive Cancer Network (NCCN) recently made updates to the NCCN Clinical Practice Guidelines in Oncology™ 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.
NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.
The NCCN Member Institutions are:
- Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
- City of Hope Comprehensive Cancer Center
- Dana-Farber/Brigham and Women's Cancer Center
Massachusetts General Hospital Cancer Center
- Duke Cancer Institute
- Fox Chase Cancer Center
- Huntsman Cancer Institute at the University of Utah
- Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
- Mayo Clinic Cancer Center
- Memorial Sloan-Kettering Cancer Center
- Moffitt Cancer Center
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
- Roswell Park Cancer Institute
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
- Stanford Cancer Institute
- University of Alabama at Birmingham Comprehensive Cancer Center
- UC San Diego Moores Cancer Center
- UCSF Helen Diller Family Comprehensive Cancer Center
- University of Colorado Cancer Center
- University of Michigan Comprehensive Cancer Center
- The University of Texas MD Anderson Cancer Center
- Vanderbilt-Ingram Cancer Center
- Yale Cancer Center/Smilow Cancer Hospital