Cervical-Cancer Screening Guidelines

The incidence of cervical cancer, as well as mortality rates from the disease, has decreased over the past 30 years because of widespread screening with cervical cytology. The American College of Obstetricians and Gynecologists (ACOG) recently published a clinical management guideline on cervical cytology screening.

Cervical-Cancer Screening Guidelines *

Age group	Screening Recommendation
<21 yr	Do not screen.
21–29 yr	Perform cytologic testing alone every 3 years.
30–65 yr	Perform cytologic and HPV cotesting every 5 years (preferred), or perform cytologic testing alone every 3 years (acceptable).**
>65 yr	Discontinue screening if there has been an adequate number of negative screening results previously (3 consecutive negative cytologic tests or 2 consecutivenegative cotests in the past 10 years, with the most recent test in the past 5 years) and if there is no history of HSIL,*** adenocarcinoma in situ, or cancer.
Women who have undergonehysterectomy	Discontinue screening if the patient has undergone a totalhysterectomy with removal of cervix and if there is no history of HSIL, adenocarcinoma in situ, or cancer.

* The three major sets of screening guidelines were issued by the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Multisociety Guidelines Group; the American College of Obstetricians and Gynecologists; and the U.S. Preventive Services Task Force (USPSTF). The guidelines agree on most recommendations, including the recommended age at the start of screening (21 years), the age at which screening can be discontinued if the history of negative screening is adequate (>65 years), and the recommended interval between tests. Specifically, cotesting at a 5-year interval is either preferred or acceptable for women 30 to 65 years of age, whereas cytologic testing alone every 3 years is acceptable for women 21 to 65 years of age. HSIL denotes high-grade squamous intraepithelial lesions.

** The terms “preferred” and “acceptable” are not included in the USPSTF Recommendation Statement.
*** HSIL includes cervical intraepithelial neoplasia grade 3 and cases of grade 2 that stain positive for p16.

References:

1. Schiffman M, Solomon D. Clinical practice. Cervical-cancer screening with human papillomavirus and cytologic cotesting. N Engl J Med. 2013 Dec 12;369(24):2324-31.[Medline]
2. Tatsas AD, Phelan DF, Gravitt PE, Boitnott JK, Clark DP. Practice patterns in cervical cancer screening and human papillomavirus testing. Am J Clin Pathol. 2012 Aug;138(2):223-9. [Medline]
3. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012;62:147-72. [Medline]
4. Moyer VA. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;156:880-91. [Medline]
5. ACOG Practice Bulletin number 131: screening for cervical cancer. Obstet Gynecol 2012;120:1222-38. [Medlione]