What are the cervical cancer screening recommendations for a 52-year-old female with a normal immune system and no history of cervical cancer?

From the Guidelines

For a 52-year-old female with a normal immune system and no history of cervical cancer, the recommended cervical cancer screening is primary human papillomavirus (HPV) testing every 5 years, which is the preferred approach, or cotesting (HPV testing in combination with cytology) every 5 years, or cytology alone every 3 years, as stated by the American Cancer Society in 2020 1.

Key Recommendations

• The screening should continue until age 65, at which point it can be discontinued if the woman has had adequate negative prior screening results, as defined by the American Cancer Society 1.
• The preferred approach is primary HPV testing every 5 years due to its higher sensitivity in detecting high-risk HPV infections that could lead to cervical cancer.
• Women should schedule these screenings with their healthcare provider, who may recommend more frequent testing based on individual risk factors or previous abnormal results.

Rationale

• Regular screening is important because it can detect precancerous changes in the cervix before they develop into cancer, allowing for early intervention.
• HPV testing is particularly valuable as most cervical cancers are caused by persistent high-risk HPV infections.
• The American Cancer Society's 2020 guideline update provides the most recent and highest-quality evidence for cervical cancer screening recommendations 1.

Considerations

• These recommendations apply to individuals who have a cervix, regardless of their sexual history or HPV vaccination status.
• Women with a history of cervical cancer, those with in utero exposure to diethylstilbestrol, or those who have a compromised immune system should receive individualized follow-up, as their risk factors may differ from those of the average population 1.

From the Research

Cervical Cancer Screening Recommendations

For a 52-year-old female with a normal immune system and no history of cervical cancer, the following screening recommendations are suggested:

• The US Preventive Services Task Force recommends screening for cervical cancer every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years 2.
• Screening with hrHPV testing alone or cotesting can detect high-grade precancerous cervical lesions and cervical cancer, and has been shown to be effective in reducing cervical cancer incidence and mortality 2, 3.
• The American Cancer Society and other organizations also recommend that women between the ages of 30 and 65 can choose to have an hrHPV test alone, a Pap test alone, or a Pap test plus an hrHPV test (cotesting) every 5 years 4, 2.

Screening Strategies

Different screening strategies have been compared in various studies:

• A study found that HPV testing has much better sensitivity than cytology to identify high-grade cervical lesions, with slightly lower specificity 5.
• Another study compared stand-alone HPV testing with cotesting strategies and found that cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals 6.
• The study also found that HPV stand-alone screening offers a better balance of benefits and harms than cotesting 6.

Screening Intervals

The recommended screening intervals are:

• Every 3 years with cervical cytology alone for women aged 21 to 29 years 2.
• Every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) for women aged 30 to 65 years 2, 3.
• Women who have had adequate prior screening and are not otherwise at high risk for cervical cancer may be screened less frequently 2.