The CMS has decided to follow the American Academy of Family Physicians' suggestion (PDF) that it begin a national coverage analysis to determine if the agency should pay for women to get a combination Pap smear and HPV test every five years to screen for cervical cancer.
Medicare now covers a screening pelvic examination and Pap test for all female beneficiaries at 12 or 24 month intervals, but does not cover HPV testing. The scope of the current review is limited to screening for cervical cancer along with HPV testing, CMS said in a posting on its site Tuesday.
The CMS is taking comments on the suggestion until Dec. 25. It then plans to issue a proposed decision by late May 2015 and a final decision by August 2015.
It is unclear what it would cost the CMS to grant coverage for the joint testing, and the agency has not yet performed a cost analysis. Generally, a Pap smear averages about $40 per screening and HPV tests range between $50 and $100.
Combination Pap smear and HPV testing every five years for women ages 30 to 65 received a grade A recommendation from the U.S. Preventive Services Task Force in March 2012.
An estimated 12,360 new cases of invasive cervical cancer will be diagnosed in the U.S. by the end of 2014, according to the American Cancer Society, and more than 4,000 women with the disease may die from it this year. Most cervical cancers occur among women who have never been screened, or who were previously inadequately screened.
Cervical cancer tends to occur in midlife, with most cases found in women younger than age 50, the health organization says. But more than 15% of cervical cancer cases are diagnosed in women over 65.
The five year co-test screening strategy has been advocated not only by the American Cancer Society, but also the American Society for Colposcopy and Cervical Pathology, the American Society for Clinical Pathology and the American Congress of Obstetricians and Gynecologists.
The groups say the decades-long practice of taking annual Pap smears has been excessive, and in some cases, harmful.
“False positives are very common with cervical cancer screening, and more frequent screening leads to more frequent need for follow-up tests that can be invasive and have unwanted side effects, including problems related to future pregnancies and delivery, as well as increased anxiety and time away from work or home,” Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society wrote on the organization's site.
“With co-testing, screening every five years provides an excellent balance between achieving extremely low cancer rates while avoiding the potential harms of unnecessary interventions,” Dr. David Chelmow, chair of the department of obstetrics and gynecology at the Virginia Commonwealth University School of Medicine, said in a statement.
Follow Virgil Dickson on Twitter: @MHvdickson
