CERVICAL CANCER SCREENING











  • Women who have had the HPV vaccine should follow the same recommendations
  • Screening guidelines endorsed by ACS, ASCCP, ASCP, USPSTF, ACOG, and ACP
Cervical Cancer Screening Recommendations
Women younger than 21 years
  • Do not screen
Women 21 - 29 years
  • Screen every 3 years with cytology
  • HPV testing should not be done on normal cytology
  • Reflex HPV testing on ASCUS is preferred
Women 30 - 65 years
  • Two options for this age group:
    • Cytology and HPV testing (cotesting) every 5 years (preferred)
    • Continue to screen with cytology every 3 years
  • USPSTF recommendation: In 2018, the USPSTF updated its recommendation to say that women in this age group could also be screened every 5 years with high-risk human papillomavirus (hrHPV) testing alone
Women > 65 years
  • Do not screen if has had adequate negative prior screening
  • Adequate prior negative screening is defined as:
    • Three consecutive negative cytology results or 2 consecutive negative HPV tests within the 10 years before ceasing screening, with the most recent test occurring within the past 5 years
    • Women with a history of CIN 2 or a more severe diagnosis should continue routine screening for at least 20 years beyond appropriate management of these lesions
Women who have had a hysterectomy
  • Do not screen women who have had a hysterectomy (with cervix removal) as long as they do not have a history of ≥ CIN 2 in the past 20 years or cervical cancer ever



  • As of 2020, the cobas® HPV and BD Onclarity™ HPV tests were FDA-approved for primary HPV screening
  • Reference [4]
ACS 2020 Cervical Cancer Screening Recommendations
Women < 25 years
  • Do not screen
Women 25 - 65 years
  • Primary HPV test alone every 5 years
Women > 65 years
  • Discontinue screening if adequate negative prior screening
  • Adequate negative prior screening defined as 2 consecutive, negative primary HPV tests, or 2 negative cotests, or 3 negative cytology tests within the past 10 years, with the most recent test occurring within the past 3 - 5 years, depending on the test used
  • Individuals aged > 65 years without documentation of prior screening should continue screening until criteria for cessation are met
After hysterectomy
  • Individuals without a cervix and without a history of CIN2 or a more severe diagnosis in the past 25 years or cervical cancer ever should not be screened
Managing HPV results




HPV FOCAL trial - Cervical HPV testing vs Cytology for Detecting CIN 3 or Worse at 48 months, JAMA (2018) [PubMed abstract]
  • The HPV FOCAL trial enrolled 19,009 women 25 - 65 years old with no history of CIN2+ in the past 5 years
Main inclusion criteria
  • Age 25 - 65 years
  • No PAP smear in last 12 months
  • No history of CIN2+ in past 5 years
Main exclusion criteria
  • HIV positive
  • Receiving immunosuppressive therapy
  • Total hysterectomy
Baseline characteristics
  • Average age - 45 years
  • Received HPV vaccine - 0.6%
Randomized screening groups
  • Group 1 (9552 patients): Cervical HPV testing
  • Group 2 (9457 patients): Cytology
  • At baseline, all patients underwent screening with the method from their assigned group
  • Patients in Group 1 with a negative test returned for follow-up at 48 months
  • Patients in Group 2 with a negative test returned for follow-up in 24 months
  • In both groups, positive tests were treated and followed-up per standard recommendations
  • All patients had HPV and cytology done at 48 months with appropriate workup for their final study diagnosis
Primary outcome: Rate of CIN 3 or worse at 48 months
Results

Duration: 48 months
Outcome HPV testing
(rate per 1000)		 Cytology
(rate per 1000)		 Comparisons
CIN3+ at 48 months 2.3 5.5 RR 0.42, 95%CI[0.25 - 0.69] p<0.001
CIN2+ at 48 months 5.0 10.6 RR 0.47, 95%CI[0.34 - 0.67] p<0.001
CIN2+ at baseline screening 15.4 9.6 RR 1.61, 95%CI[1.24 - 2.09] p<0.001

Findings: Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months. Further research is needed to understand long-term clinical outcomes as well as cost-effectiveness.