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Benefit Changes Affect Members Beginning January 1, 2017

Task Force Recommends Reduction in Cervical Screenings

Study indicates women no longer need annual screenings

In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended that most women only need cervical cancer screenings every three years after evidence indicated no added benefit to annual screenings.This change is supported by a broad coalition of medical specialty societies, including the American Cancer Society, the American College of Physicians and the American Congress of Obstetrics and Gynecology.

Starting in January 2017, all Arkansas Blue Cross and Blue Shield members will need to follow the new cervical screening guidelines, unless noted below.

Cervical Screening Policy Implemented January 1, 2017

AGE RECOMMENDATION/BENEFIT
Under 21 No screening
21 - 65 Pap test every three years
30 - 65 Pap test every three years
             OR
Pap test and co-testing for HPV every five years
65 and older No screening
If you have had a hysterectomy with removal of cervix for a benign (noncancerous) disease, a Pap test is not necessary.

Exceptions

These recommendations do not apply to women who:

  • Are at high risk for cervical cancer because they:
    • Have had in-utero exposure to diethylstilbestrol (DES)
    • Are immunocompromised (such as those who are HIV positive)
  • Are being followed for an abnormality on a Pap test

In these situations the test would be considered diagnostic and would not be covered under preventive services.

Pap tests detect abnormal cells in a woman’s cervix before they become cancerous. Part of the test may include a human papillomavirus (HPV) DNA test to identify high-risk forms of HPV that cause cervical cancer. Women vaccinated for HPV still need cervical cancer screenings because the vaccines do not protect against all cervical cancers.

Absolutely. There is no treatment for HPV infections except time; the body clears up most HPV infections in eight to 24 months, so more frequent screenings would not help eradicate an infection.

The real concern is cervical cancer, which can take 10 to 12 years to develop. This means regular screenings according to the new schedule allow for ample time to detect abnormalities.

Our medical policy regarding these screenings changed on January 1, 2016, and our coverage will change on January 1, 2017.

If you are between the ages of 21-65 and received a Pap test as a screening service in 2015, you will not have 100 percent preventive coverage of another screening until three years have passed. If a doctor thinks a test is needed for health reasons, it will be covered as a diagnostic test (not a screening), which may require a copayment. If you had a Pap test last year you won’t have coverage for screening purposes for three years from the time of your last screening.

Many doctors began switching patients to this schedule in 2013 when the recommendation was announced by the USPSTF. Arkansas Blue Cross reviewed the information from the USPSTF thoroughly before determining that our medical policy should reflect the recommendation.

Cervical cancer can take 10 to 12 years to develop. This testing schedule allows for early detection and minimizes unnecessary tests. In more than 90 percent of women with HPV, the infection will clear up on its own over eight to 24 months.

Screening women too young, too frequently or beyond a certain age does not improve the prevention of cervical cancer. Too many screenings exposes women who have an average risk and are without symptoms to the recognized harms of inappropriate screening:

  • Pain and bleeding with cervical biopsies and excisional treatments
  • Unnecessary worry and appointments
  • Potential problems with child bearing due to unnecessary biopsies and false positive testing

The USPSTF is an independent, volunteer panel of national experts that make evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications. Visit uspreventiveservicestaskforce.org for more information.