From the Guidelines
Cervical cancer screening should begin at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years. The American Cancer Society recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) 1.
Some key points to consider:
- The recommended age to start screening is 25 years, which is a change from previous guidelines that recommended starting at age 21 years.
- Primary HPV testing is the preferred screening strategy, with cotesting and cytology alone as acceptable alternatives.
- Screening can be discontinued after age 65 years if there is a history of adequate negative prior screening in the prior 10 years, and no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years.
- Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons generally don't need screening.
- Those with a history of cervical cancer or high-grade precancerous lesions should continue screening for at least 20 years after treatment, even if this extends beyond age 65.
It's worth noting that these guidelines aim to detect precancerous changes early when treatment is most effective, while avoiding unnecessary procedures in low-risk populations. HPV testing is increasingly preferred because it detects the virus that causes most cervical cancers, while Pap tests look for cellular changes that may indicate precancer or cancer.
The most recent guidelines from the American Cancer Society, as outlined in the 2020 update, should be followed, as they provide the most up-to-date recommendations for cervical cancer screening 1.
From the Research
Cervical Cancer Screening Guidelines
The recommended guidelines for cervical cancer screening are as follows:
- Women under 21 years old should not be screened for cervical cancer, regardless of their sexual activity 2
- Women between 21 and 30 years old should be screened every 3 years with a Papanicolau (Pap) test 2
- Women between 21 and 65 years old can be screened with an HPV test, and if positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment 3
- Women over 65 years old who have participated adequately in screening programs do not need to continue screening 4
Screening Methods
The following screening methods are available:
- Pap test: a conventional method for screening cervical cancer, but with lower sensitivity compared to HPV testing 5, 6
- HPV testing: a more sensitive method for detecting high-grade cervical intraepithelial neoplasia or cancer, and can be used as a stand-alone test or in combination with Pap testing 3, 5, 6
- Liquid-based cytology (LBC): a method that can be used in combination with HPV testing, but with equivalent specificity to stand-alone HPV testing 6
- Cotesting: a strategy that combines Pap testing with HPV testing, but may result in more false positive results and colposcopy referrals compared to stand-alone HPV testing 6
Special Populations
Special populations at greatest risk may require more frequent screening or alternative methods, such as:
- Women with a history of cervical cancer or precancerous lesions
- Women with a weakened immune system
- Women who have been exposed to diethylstilbestrol (DES) in utero 4