Cervical Cancer Screening for a 46-Year-Old Woman
For a 46-year-old woman with normal Pap test results, screening should be performed every 3 years with cytology alone OR preferably every 5 years with HPV and cytology co-testing (HPV/Pap co-test). 1
Recommended Screening Approach
For women aged 30-65 years (which includes our 46-year-old patient):
- Preferred approach: HPV and cytology co-testing every 5 years 2, 1, 3
- Acceptable alternative: Cytology (Pap test) alone every 3 years 2, 1, 3
The American Cancer Society, American Society for Colposcopy and Cervical Pathology, American Society for Clinical Pathology, and the US Preventive Services Task Force all agree on these recommendations 2, 1.
Important Considerations
Benefits of Co-testing
- Co-testing (HPV plus Pap) is more sensitive than cytology alone for detecting cervical precancers 2, 3
- The longer 5-year interval with co-testing is safe and effective due to this increased sensitivity 1
- HPV testing helps identify women at higher risk for developing cervical cancer 2
Screening Intervals
- Annual screening is NOT recommended for any age group 2
- Extending from annual to every 3 years screening with cytology alone reduces screening effectiveness by less than 5% 2
- Despite guidelines recommending extended intervals, studies show many physicians still recommend more frequent screening than necessary 4, 5
Special Considerations
- The patient's screening history should be documented
- If the patient has risk factors (immunocompromised status, prior history of high-grade cervical lesions, in utero DES exposure), more frequent screening may be warranted 1
- Previous normal results should be verified before extending intervals 1
Future Screening Considerations
- Screening should continue until age 65 if results remain normal 2, 1
- Screening can be discontinued at age 65 if there have been at least 3 consecutive negative Pap tests or 2 consecutive negative co-tests within the past 10 years, with the most recent test occurring within the past 5 years 2, 1
Common Pitfalls to Avoid
- Over-screening: Many providers continue to recommend annual screening despite evidence that longer intervals are safe and effective 4, 5
- Under-utilization of co-testing: Geographic variations exist in the uptake of co-testing, with some regions having significantly lower rates 6
- Premature discontinuation: Never discontinue screening before age 65 in average-risk women 1
- Failure to document: Always verify and document adequate prior screening before extending intervals 1
By following these evidence-based guidelines, providers can optimize cervical cancer detection while minimizing unnecessary procedures and patient anxiety.