Cervical screening
==================

* James Dickinson
* Gabriela Lewin
* Elizabeth Shaw
* Harminder Singh
* Michel Joffres
* Richard Birtwistle
* Marcello Tonelli
* Verna Mai

Several recent publications have challenged parts of the new Canadian Task Force on Preventive Health Care (CTFPHC) guideline on Cervical Screening1: a commentary by Dollin,2 a joint statement by the Society of Obstetricians and Gynaecologists, the Society of Gynaecological Oncologists, and the Society of Canadian Colposcopists,3 and a *CMAJ* eletter by Murphy and Elit.4 These writers agree with the CTFPHC’s recommendations to screen women aged 30 to 70 and not to screen women under age 20. The writers raise 3 main issues: age of commencement, whether to vary initiation according to women’s individual preferences and risk assessment, and use of human papillomavirus (HPV) testing. We have written a detailed rebuttal of these critiques, available on the *CMAJ* and Task Force websites.5

Each writer has misquoted the CTFPHC, misunderstood the strength of the evidence, what evidence was used, or why we did not recommend HPV screening. The CTFPHC chose to await outcomes of ongoing trials of HPV testing. The evidence for all recommendations had at least moderate strength, but for young women, the balance of benefits against harms was equivocal and assessment of its importance is individual, and therefore lead to the weak recommendations.

The CTFPHC recommends that women aged 20 to 29 should make their own choices and start getting pap tests in their mid-20s, after discussion with their health care providers. We urge provincial guideline groups and individual doctors to focus on communicating risk information to women who can then make personal choices — this includes those women who are currently having regular tests and those who are not. To assist in this process, we have produced education tools, which are available on the CTFPHC website at [http://canadiantaskforce.ca/resources/](http://canadiantaskforce.ca/resources/)

## References

1.  Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer. CMAJ 2013;185:35–45.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo4OiIxODUvMS8zNSI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xODUvMTQvMTI1Mi4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Dollin J. Preventing cervical cancer: beyond following guidelines. CMAJ 2013;185:13–14.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo4OiIxODUvMS8xMyI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xODUvMTQvMTI1Mi4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  Position statement: recommendations on screening for cervical cancer. Society of Obstetricians and Gynaecologists of Canada, Society of Gynecological Oncology of Canada, Society of Canadian Colposcopists; 2013.
    
    

4.  Murphy KJ, Elit L. Cervical screening guidelines — discordance discussed [eletter]. CMAJ; 2013 Mar. 22.
    
    

5.  Dickinson J; for the CTFPHC working group on Cervical Screening. Cervical screening: making the right change is more important than concern about discord [eletter]. CMAJ; 2013 May 6.