Updated human papillomavirus vaccination and testing recommendations from the American Cancer Society

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Human papillomavirus (HPV) is one of the most common causes of sexually transmitted disease worldwide.¹ It is associated with a variety of clinical conditions that can range from cutaneous warts to cervical or anal cancer.¹ Cervical cancer is the third most common cancer in women in the United States, and may constitute up to 25% of all female cancers in developing countries.¹ Vaccines have been developed for the prevention of HPV infection, and are recommended for females at age 11-12.² Routine screening is also critical for the detection of HPV infections and prevention of cervical cancer, of which the Papanicolaou (pap) smear is the method of choice.² The United States Food and Drug Administration (FDA) also approved a polymerase-chain reaction-based HPV test for the primary screening of cervical cancer in 2014, of which two approved tests are currently available.^2,3

Recently, the American Cancer Society (ACS) has released updated guidelines regarding HPV vaccination and cervical cancer screening, which differ slightly from the 2019 Federal Advisory Committee on Immunization Practices (ACIP) recommendations.^3,4 While the ACIP recommends HPV vaccination at age 11 or 12, and can be given starting at age 9, the ACS recommends that healthcare providers to start offering the HPV vaccine at age 9 or 10.⁴ Notable, HPV vaccination has been shown to be more effective at younger ages, and vaccination has shown no signs of protection waning over time.⁴

The ACIP also recommends that vaccination is recommended for all persons through age 26 years who are not adequately vaccinated.⁴ In their updated guidelines, the ACS has added a qualifying statement that advises providers to inform individuals aged 22-26 years who have not been previously vaccinated or who have not completed the vaccination series that vaccination at older ages is less effective in lowering cancer risk.⁴ While the ACIP has recommended share decision making regarding HPV vaccinations in some adults aged 27-45 years who are not adequately vaccinated, the ACS does not endorse this statement, due to the low effectiveness and low cancer prevention potential of vaccination in this age group, burden of decision making on patients and clinicians, and lack of sufficient guidance on which select individuals may benefit.⁴

Regarding cervical cancer screening, the updated ACS guidelines recommend that cervical cancer screening should begin at age 25 in average-risk individuals, as compared to age 21 in the 2012 guideline. The updated guidelines also recommend HPV testing with an FDA-approved HPV test every 5 years as the preferred method for primary screening.³ Previously, the 2012 guidelines recommended cytology alone every 3 years until age 29, and a preferred switch to co-testing (HPV testing in combination with cytology) from ages 30-65.³ This is due to inferior sensitivity with cytology testing, which thus provides less assurance regarding future risk of cervical cancer.³ While co-testing offers little incremental benefit in detection but increases the number of procedures a patient must encounter, it is included as an acceptable option for screening as accessibility and availability of HPV testing is currently implemented across the United States.³

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Reference

Burd EM. Clin Microbiol Rev. 2003;16(1):1-17.

Harden ME et al. Mutat Res. 2017;772:3-12.

Fontham ETH et al. CA Cancer J Clin. n/a(n/a).

Saslow D et al. CA Cancer J Clin. n/a(n/a).

Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).