Cervical Screening Across Borders: Differences in Guidelines in the UK, USA, and Canada

Cervical screening is a preventive measure that aims to detect and treat cervical cancer before it causes symptoms or spreads to other parts of the body. Cervical screening involves testing for human papillomavirus (HPV), a common sexually transmitted infection that can cause abnormal cells on the cervix, and/or examining the cells under a microscope for signs of precancerous or cancerous changes. Cervical screening can help prevent cervical cancer, which is one of the most common cancers among women worldwide.

However, different countries have different guidelines and recommendations for cervical screening, based on their epidemiological data, health system resources, and scientific evidence. In this article, we will compare the cervical screening practices in the UK, the USA and Canada.

The UK: The NHS Cervical Screening Programme

The NHS Cervical Screening Programme (NCSP) offers cervical screening to women aged 25 to 64 in England. The NCSP recommends that women aged 25 to 49 receive an invitation every three years by mail, and women aged 50 to 64 receive an invitation every five years by mail. Women who are registered with a GP (as female) automatically receive an invitation by mail. Trans men (assigned female at birth) do not receive invitations if registered as male with their GP, but are still entitled to screening if they have a cervix.

The NCSP uses two types of tests: cytology (also known as Pap test) and HPV testing. A cytology test involves collecting a sample of cervical cells with a scraper or brush and sending it to a laboratory for analysis. An HPV test involves taking a sample of cervical cells with a swab or liquid-based cytology device and sending it directly to a laboratory for analysis. Both tests look for abnormal cells that can indicate HPV infection or cervical cancer.

The NCSP follows the guidelines from Public Health England (PHE), which are based on evidence from clinical trials and expert consensus. PHE’s guidelines recommend that women should be screened every three years with cytology alone until they reach age 49, then every five years with cytology alone until they reach age 65, then every five years with HPV testing alone until they reach age 65. PHE also recommends that women who have had adequate prior screening (i.e., three consecutive negative tests in the last 10 years) should not be screened again.

The USA: The ACS Guidelines

The American Cancer Society (ACS) publishes guidelines for cervical cancer screening every two years based on current scientific knowledge and expert opinion. The ACS’s latest guidelines were published in July 2020. The ACS’s guidelines recommend that women aged 21 to 29 should be screened every three years with cytology alone; women aged 30 to 65 should be screened every three years with cytology alone or HPV testing alone; and women older than 65 should not be screened if they have had adequate prior screening.

The ACS’s guidelines also recommend that women who are at high risk for cervical cancer due to factors such as HIV infection, compromised immune system, in utero exposure to diethylstilbestrol (DES), or previous treatment of high-grade precancerous lesions or cervical cancer should receive individualized follow-up based on their risk level.

The USA follows the recommendations from various organizations such as the US Preventive Services Task Force (USPSTF), which is an independent panel of experts appointed by Congress; the American College of Obstetricians and Gynaecologists (ACOG), which is the leading professional organization representing gynaecologists; and individual states such as California, New York, Texas, etc., which may have their own variations in screening programs.

Canada: The Canadian Task Force

The Canadian Task Force on Preventive Health Care (CTFPHC) provides recommendations for preventive health care interventions based on systematic reviews of evidence from randomized controlled trials and other sources. The CTFPHC’s latest recommendations were published in June 2019. The CTFPHC’s recommendations recommend that women aged 21 or older who are sexually active should start having regular Pap tests by age 21; Pap tests should be done every one to three years depending on previous test results; HPV testing should be done every two to three years starting at age 25; Pap tests should be done every two years starting at age 35 if there are no previous negative results; Pap tests should be done every year starting at age 45 if there are no previous negative results; Pap tests should be done every year starting at age 50 if there are no previous negative results; Pap tests should be done every year starting at age 55 if there are no previous negative results; Pap tests should be done every year starting at age 60 if there are no previous negative results; Pap tests should be done every three years starting at age 60 if there are no previous negative results.

The CTFPHC also recommends that women who are at high risk for cervical cancer due to factors such as HIV infection, compromised immune system, in utero exposure to diethylstilbestrol (DES), or previous treatment of high-grade precancerous lesions or cervical cancer should receive individualized follow-up based on their risk level.

In conclusion, while the UK, the USA, and Canada all have cervical screening programs, the specifics of these programs vary. These differences reflect the unique healthcare systems, population demographics, and scientific evidence available in each country. As healthcare professionals, it is crucial to understand these differences to provide the best care for patients and to advocate for effective cervical screening programs.

If you want to read more on cervical cancer and cervical screening in the United Kingdom, check out the Practitioner Development UK article An Overview of Cervical Cancers and Screening Guidelines in the UK.

Please note that this information is current as of December 2023 and may change as new research becomes available. Always refer to the latest guidelines from relevant health authorities when making clinical decisions.

References

American Cancer Society, 2023. Cervical Cancer Screening Guidelines. [online] Available at: https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html [Accessed 26 December 2023].

Canadian Task Force on Preventive Health Care, 2023. Recommendations on screening for cervical cancer. [online] Available at: https://canadiantaskforce.ca/guidelines/published-guidelines/cervical-cancer/ [Accessed 26 December 2023].

NHS, 2023. Cervical Screening Programme. [online] Available at: https://www.nhs.uk/conditions/cervical-screening/ [Accessed 26 December 2023].

World Health Organization, 2023. Comprehensive cervical cancer control: a guide to essential practice. [online] Available at: https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/ [Accessed 26 December 2023].