recommendations for performing Papanicolaou (Pap) smear

Notes

American Cancer Society & American College of Obstetricians & Gynecologists

• age 21
• every 2 years until age 30, then every 3 years after 3 consecutive, technically satisfactory normal/negative cytology results
• women risk factors may require more frequent screenings:
  • HIV
  • immunosuppression
  • in utero exposure to DES
  • history of cancer or cervical intraepithelial neoplasia
• after 3 or more consecutive normal exams, the Pap smear may be performed less frequently at the discretion of her physician
• may discontinue at age 65-70

US Preventive Services Task Force

• Pap smears every 1-3 years beginning with onset of sexual activity, until age 65
• after age 65, screening is unnecessary if previous smears have been consistently normal

American Geriatrics Society

• screen at 1-3 year intervals until age 70
• beyond age 70, little evidence for or against screening women who have regularly been screened in previous years
• older women of any age who have never been screened should be screened until 3 negative Pap smears are obtained 1 year apart (GRS9)*
  • issue of including HPV DNA screening discussed inadequately
• continue screening in women > 65 years until 3 negative Pap smears obtained 1 year apart if patient has a new sexual partner since prior Pap smears

Medicare covers Pap Smears for women over 65 years of age

In 2004 the National Cancer Institute, American Society of Colposcopy & Cervical Pathology & American Cancer Society cosponored a workshop to develop consensus guidelines

• HPV DNA testing may be added to cervical cytology screening for women > 30 years of age
• women in whom both cytology & HPV DNA testing are negative need not be screened again for 3 years
• women with negative cytology but infected with high-risk type of HPV should be rescreened in 6-12 months
  • if either repeat test is positive, colposcopy is indicated
• women who test negative for HPV by DNA testing with cytology showing atypical squamous cells of unknown significance (ASCUS) can be followed with repeat cytology in 12 months
• women with atypical sqaumous cells - cannot exclude high-grade intraepithelial neoplasia or intraepithelial neoplasia should undergo colposcopy