screening for cervical cancer

Management

Recommendations:

• recommendations for average risk women regardless of sexual history or HPV vaccination status
  • begin screening for average risk age women at 25 years (ACS)
    • screening women age 21-65 every 3 years (USPSTF)
  • women younger than 21 years should not be screened regardless of sexual history
  • stand-alone HPV testing every 5 years through ages 25-65 years (ACS)
  • high risk HPV testing to begin at age 30 years (USPSTF)
  • cervical cytology alone every 3 years if HPV testing not available
  • women > 65 years of age should not be screened if sufficient previous screening
  • women without cervix after hysterectomy should not be screened (see below)
• other screening recommendations
  • in a resource-limited setting, women 30-49 years of age can be screened every 10 years with HPV DNA
  • for women who have completed HPV vaccination
    • screening still recommended
      • apparently sceening same with or without HPV vaccination
    • screening every 5 years beginning at age 25-30 years with either cytology or HPV DNA testing (bivalent or quadrivalent vaccine)
    • screening every 10 years beginning at age 30-35 years with HPV DNA testing
    • HPV DNA testing associated with significantly increased detection of high-grade precancerous cervical lesions compared to cytology
  • women with risk factors may require more frequent screenings:
    • HIV
    • immunosuppression
    • in utero exposure to DES
    • history of cancer or cervical intraepithelial neoplasia
  • if cervical cytology is unsatisfactory, repeat Pap smear
  • may discontinue screening at age 65-70
    • discontinue screening at age 65 provided sufficient negative screening results
      • 3 consecutive negative Pap smears or 2 consecutive negative Pap smears + negative HPV DNA testing
      • most recent negative screening test must be within 5 years
      • no history of cervical intraepithelial neoplasia grade 2 or higher
  • 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
  • do not screen women after hysterectomy with removal of the cervix for benign disease unless history of cervical intraepithelial neoplasia grade 2 or higher, regardless of history of ovarian cancer or endometrial cancer
• bimanual examination not recommended as part of screening
• HPV DNA testing for papillomavirus (cervical specimens)
  • outperforms cytology for reducing risk of invasive cervical carcinoma
  • negative HPV DNA more predictive than negative cytology for absence of cervical cancer
  • because of poor specificity, <A487344>HPV DNA testing</A487344> with cytology is not recommended
  • urine specimen potentially an alternative
  • HPV testing should not be performed before age 30
• self-collected cervicovaginal samples for HPV testing & STD testing
• screening for chlamydia (Chlamydia DNA) & gonorrhea (Neisseria gonorrhoeae DNA) from urine or self-collected vaginal swabs

Also see recommendations for performing Pap smears

Notes

• 88% of women comply with USPSTF recommendations for screening, yet 47% of cervical cancers present at late stage
  • 11% of US women not screened in past 5 years (2012)
• prognoses for women with cervical cancer may be better if detected by screening rather than upon workup of symptoms
• 19 algorithms too complicated to memorize
• HPV vaccination status does not alter recommendations for cervical cancer screening
• cervical cancer screening in average-risk women is still initiated too soon & continued for too long
• women never screened with 1 in 45 risk of developing cervical cancer in their lifetime
• adherence to cytology screening until age 55 lowers risk to 1 in 138; screening until age 70, lower risk to 1 in 160.
• screening up to age 55 with negative cytology with 1 in 440 risk of developing cancer; risk is 1 in 1940 with a negative HPV test, & 1 in 2253 with negative HPV-cytology cotesting

More general terms

• screening for cancer

Additional terms

• cervical cancer
• Papanicolaou (Pap) smear

Patient information

screening for cervical cancer patient information