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 every 5 years (preferred)
    • Continue to screen with cytology every 3 years
  • 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




  • Reference [2]
CERVICAL CANCER SCREENING WITH HIGH-RISK HPV TESTING ONLY
WOMEN < 25 YEARS
  • Do not screen with high-risk HPV testing
WOMEN ≥ 25 YEARS
  • May screen with high-risk HPV testing
  • If negative, rescreen in ≥ 3 years (optimal interval has not been determined, but should not be sooner than 3 years)
MANAGING HPV RESULTS
  • Negative - rescreen in ≥ 3 years (optimal interval has not been determined, but should not be sooner than 3 years)
  • Type 16 or 18 positive - proceed to colposcopy
  • Other high-risk HPV positive - perform cytology (PAP smear)
    • If cytology is negative, follow-up in 12 months
    • If cytology comes back ASCUS or greater - perform colposcopy



  • Reference [3]
MANAGING ABNORMAL SCREENING RESULTS
WOMEN 21 - 29 YEARS
  • HPV-positive ASCUS or LSIL(CIN 1) or greater - refer to ASCCP algorithm (ASCCP algorithm)
  • HPV-negative ASCUS - rescreen with cytology in 3 years
WOMEN 30 - 65 YEARS
  • If screening every 5 years with HPV and cytology:
    • HPV-negative ASCUS - rescreen with cotesting in 5 years
    • HPV-positive ASCUS or LSIL(CIN 1) or greater - refer to ASCCP algorithm (ASCCP algorithm)
    • HPV-positive, cytology negative
      • Two options for this group:
        • Option 1: 12-month follow-up with cotesting
        • Option 2: Test for HPV16 or HPV16/18 genotypes:
          • If HPV16 or HPV16/18 positive: refer for colposcopy
          • If HPV16 or HPV16/18 negative: 12-month follow-up with cotesting

  • If screening every 3 years with cytology:
    • HPV-positive ASCUS or LSIL(CIN 1) or greater - refer to ASCCP algorithm (ASCCP algorithm)
    • HPV-negative ASCUS - rescreen with cytology in 3 years