NEW CERVICAL CANCER SCREENING STRATEGY WITH CONTESTING OF CYTOLOGY AND HPV TESTING

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Abstract

The Japan Association of Obstetricians and Gynecologists (JAOG) recommended screening for cervical cancer in women age 20 to 65 years with a combination of cytology and human papillomavirus (HPV) testing every 3 years in 2011. The US Preventive Services Task Force (USPSTF) and a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP) recommendations are published in 15 March 2012. The recommendations are based on a systematic evidence review. The new screening recommendations address age-appropriate screening strategies, including the use of cytology and high-risk human papillomavirus (HPV) testing. Although the two sets of guidelines were developed independently, they are generally consistent. Screening with cytology and HPV testing every 5 years or cytology alone every 3 years in women age 21 to 65 years is recommended. On the other hand, HPV testing alone as a primary screening approach will be planed in Europe. Recommended screening practices should not change on the basis of HPV vaccination status. Specifically, co-testing has increased sensitivity for detecting cervical intraepithelial neoplasia grade 3 or greater (CIN3+), and women who have undergone co-testing have a lower risk of CIN3+ and invasive cancer. Because of this improved performance, co-testing can be used for screening at less frequent intervals than cytology alone. In addition, co-testing offers greater risk reduction than cytology alone for adenocarcinoma of the cervix and its precursors. However, Guideline of Japanese Ministry of Health, Labor and Welfare (MHLW) still shows a screening with cytology every 2 years. Now, we are keen to change the guideline of cervical cancer screening based on the latest evidences in Japan. Our new recommendation will be shown with data based on the medico-economic analysis in this work shop.

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