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Dear Editor,
I am writing in regard to Popadiuk et al.’s commentary on the start age of cervical cancer screening. The statement the Canadian Task Force recommends screening to begin at age 25 needs further clarification. The commentary does not mention the strength of the recommendation, nor how it should be applied. While in the Task Force’s 2013 paper, the Task Force specifies it is a weak recommendation, and screening should not be uniformly started at the age of 25. Instead the decision of when to start screening, in the 25 to 30 age group, should be based on the risk and preferences of each individual women.1
As a family physician in Alberta, I have many low risk patients in this age group that have made the informed decision to wait until 30 for their first PAP. I feel it is particularly important to have this discussion, instead of just starting to screen at 25 years old, due to the invasiveness and opportunity cost of the procedure.
Also, I found it notable only 2 provinces have updated their guidelines to align with the Task Force recommendations, as soon the 2013 Canadian Task Force guidelines may itself need to be updated. Many jurisdiction worldwide including the Netherlands, Italy, Norway, England, Australia and New Zealand have or are in the process of changing to primary HPV screening with reflex cytology. The reasons cited are increased sensitivity, less frequent screening intervals, decreased cost and a projected decrease in incidence and mortality.2
1Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer. CMAJ 2013;185:35–45.
2 Lew JB, Simms KT, Smith MA, et al. Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program. Lancet Public Health 2017;2:e96-107.