USA Today Op-ed: New Cervical Cancer Screening Guidelines Dismiss Best Practices
If the pandemic has taught us anything, it’s the more testing, the better. So why is the American Cancer Society recommending women get fewer tests?
The American Cancer Society issued at the end of July new guidelines for cervical cancer screening that call for fewer women to be tested and stand in direct opposition to recommendations from leading scientific organizations. As someone who has devoted their life to fighting for better and more accessible health care for women, I know that the disservice these changes will have on society, and women specifically, could not come at a worse time.
The global health crisis we are living through right now is a stark reminder of just how dangerous a course of action the American Cancer Society’s new guidelines may set in motion. In fact, while COVID-19 and cervical cancer are vastly different diseases, there are three important lessons related to the rollout and implementation of testing we should be learning in real time. The American Cancer Society’s new guidelines ignore them all.
First, if the experience of the coronavirus has taught us anything, it’s that testing — widespread, science-driven and accessible testing — is crucial to understanding and combating disease. The more accurate testing we offer people, the better. Testing allows earlier detection and diagnoses and, when necessary, treatment. We know that while companies have been able to significantly ramp up production, the challenges people had in getting access to testing for COVID-19 in the early months likely intensified the crisis.
Where the current cervical cancer screening guidelines advise the Pap test for women starting at age 21, the new American Cancer Society guidelines advise delaying testing altogether until women turn 25, and then, preferably, solely with the HPV test every five years thereafter. This is despite the fact we know that the HPV test alone is less effective than co-testing along with the Pap test.
Not only does the American Cancer Society threaten the use of the life-saving Pap test, and recommend phasing it out entirely, but that four-year wait likely means fewer women cumulatively will be tested. If just having a cervix puts women at risk of a potentially fatal disease, it’s a wait most woman may prefer to avoid.
Secondly, one of the most demoralizing responses to the current pandemic has been the disregard in some quarters for science, data, facts and the hard-won insights of the health care community. That the American Cancer Society, an organization I have long admired, should now fall into this category with its new guidelines is especially disheartening. Let’s look at the science.
In a highly diverse and the largest cervical cancer screening study ever, the results of which were released in early July, co-testing with the Pap test and HPV test identified 94.1% of cervical cancer cases and 99.7% of pre-cancer cases in women who would be diagnosed within 12 months.
Co-testing remains the most effective strategy for detecting cervical cancer and precancer in women, but it is listed as an inferior choice by the new guidelines. Furthermore, that study demonstrates the use of HPV testing alone, which the American Cancer Society now recommends, misses twice as much cervical cancer as co-testing. We cannot disregard the science; we must follow it.
Finally, mixed messages around coronavirus testing have sown confusion about who should get tested, and when. It has introduced uncertainty where there should be certainty and has led patients and even some health care professionals to question aspects of the system they rely on and trust. This isn’t a result we want to replicate when it comes to cervical cancer screening.
The American Cancer Society guidelines stand at odds with the previous guidelines that have helped drive a decrease in cervical cancer rates by 70% since the Pap test was introduced more than 50 years ago. They may introduce confusion about which tests to get and when, which in effect is building another barrier between women and the health care they deserve. The current challenges posed by testing in the time of COVID-19 has shown us just how dangerous such barriers can be.
An estimated 4,300 women will die in the United States from cervical cancer this year. Clarity drives trust and trust is essential to making progress in fighting this cancer.
With racial disparities in health care finally receiving the attention they deserve, and given what we are living through with the pandemic, it would be a tragedy if we do not at the very least learn from it. With a little tweak, George Santayana’s admonition that “those who cannot remember the past are condemned to repeat it” can provide the most important insight of all. When it comes to the American Cancer Society’s new guidelines on cervical cancer screening, it’s not lessons from the past I’m worried we’re ignoring, but lessons from the here and now.
A failure to acknowledge the lessons of this moment by loosening commonsense screening guidelines will almost surely reverse the progress we have made in combating cancer in recent years. If we allow this to be our future then we have learned nothing, and more women may die because of it.