Screening Guidelines

New Cervical Cancer Screening Guidelines Announced

Click here to download the full .pdf document of screening guidelines.

Summary of Recommendations and Conclusions

The following recommendations are based on good and consistent scientific evidence (Level A):

• Cervical cancer screening should begin at age 21 years. Screening before age 21 should be avoided because it may lead to unnecessary and harmful evaluation and treatment in women at very low risk of cancer.
• Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years.
• Women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of CIN 2 or CIN 3, are not HIV infected, are not immunocompromised, and were not exposed to diethylstilbestrol in utero may extend the interval between cervical cytology examinations to every 3 years.
• Both liquid-based and conventional methods of cervical cytology are acceptable for screening.
• In women who have had a total hysterectomy for benign indications and have no prior history of highgrade CIN, routine cytology testing should be discontinued.
• Co-testing using the combination of cytology plus HPV DNA testing is an appropriate screening test for women older than 30 years. Any low-risk woman aged 30 years or older who receives negative test results on both cervical cytology screening and HPV DNA testing should be rescreened no sooner than 3 years subsequently.

The following recommendations are based on limited and inconsistent scientific evidence (Level B):

• Sexually active adolescents (ie, females younger than age 21 years) should be counseled and tested for sexually transmitted infections, and should be counseled regarding safe sex and contraception. These measures may be carried out without cervical cytology and, in the asymptomatic patient without the introduction of a speculum.
• Because cervical cancer develops slowly and risk factors decrease with age, it is reasonable to discontinue cervical cancer screening between 65 years and 70 years of age in women who have three or more negative cytology test results in a row and no abnormal test results in the past 10 years.
• Women treated in the past for CIN 2, CIN 3, or cancer remain at risk for persistent or recurrent disease for at least 20 years after treatment and after initial posttreatment surveillance, and should continue to have annual screening for at least 20 years.
• Women who have had a hysterectomy with removal of the cervix and have a history of CIN 2 or CIN 3—or in whom a negative history cannot be documented— should continue to be screened even after their period of posttreatment surveillance. Whereas the screening interval may then be extended, there are no good data to support or refute discontinuing screening in this population.

The following recommendations are based primarily on consensus and expert opinion (Level C):

• Regardless of the frequency of cervical cytology screening, physicians also should inform their patients that annual gynecologic examinations may still be appropriate even if cervical cytology is not performed at each visit.
• Women who have been immunized against HPV-16 and HPV-18 should be screened by the same regimen as nonimmunized women.