Cervical Cancer Screening

Cervical Cancer Screening Summary of Recommendations and Evidence (from JAMA)

USPSTF recommends (does not apply to individuals who have been diagnosed with a high-grade precancerous cervical lesion or cervical cancer; individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (eg, women living with HIV)

1. screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years (women who have a cervix, regardless of their sexual history or HPV vaccination status) 

2. For women aged 30 to 65 years, screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) 

3. NO screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. 

4. NO screening for cervical cancer in women younger than 21 years

5. NO screening in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer

ACS/ASCCP/ASCP recommend  

1. YES screening: women aged 21 to 29 years be screened every 3 years with cytology alone (cervical cytology or Pap testing). 

2. YES screeing: Women aged 30 to 65 years should be screened every 5 years with cytology and HPV testing or every 3 years with cytology alone. 

3. Women at increased risk of cervical cancer (ie, women with a history of cervical cancer, a compromised immune system, or diethylstilbestrol exposure) may need to be screened more often. 

4. Women who have had CIN 2+ should continue screening for 20 years after the last abnormal test result, even if it extends screening beyond age 65 years.

ASCCP and SGO guidance (2015)

1. recommended primary HPV screening starting at age 25 years as an alternative to cytology alone or cotesting.

The American Academy of Family Physicians guidelines are in agreement with the USPSTF.

The American College of Obstetricians and Gynecologists (2016) that cytology alone and cotesting are still specifically recommended in current guidelines from most major societies; however, primary HPV screening in women 25 years or older can be considered as an alternative to current cytology-based screening if performed per ASCCP and SGO interim guidance.