What are the cervical cancer screening guidelines according to American Society for Colposcopy and Cervical Pathology (ASCCP), International Federation of Gynecology and Obstetrics (FIGO), and Federation of Obstetric and Gynecological Societies of India (FOGSI)?

Cervical Cancer Screening Guidelines: ASCCP, WHO, FIGO, and FOGSI

Cervical cancer screening should begin at age 21, with cytology alone every 3 years for women aged 21-29, and for women aged 30-65, either HPV testing every 5 years (preferred), cotesting (HPV+cytology) every 5 years, or cytology alone every 3 years, with screening discontinuation after age 65 if adequate prior screening has been documented. 1, 2, 3

Age to Begin Screening

• Start at age 21 years regardless of sexual initiation or other risk factors 1
• Women under age 21 should NOT be screened 1
• Rationale: Cervical cancer is rare in adolescents, and screening leads to unnecessary procedures and potential overtreatment of lesions that would likely regress spontaneously 1

Screening Recommendations by Age Group

Women Ages 21-29

• Screening with cytology (Pap test) alone every 3 years 1, 2
• HPV testing should NOT be used in this age group (either as stand-alone or cotest) 1
• Rationale: High prevalence of transient HPV infections in this age group would lead to unnecessary follow-up and potential harm 1

Women Ages 30-65

• Preferred approach: Primary HPV testing every 5 years 2, 3
• Acceptable alternatives:
  • Cotesting (HPV + cytology) every 5 years 1, 2, 3
  • Cytology alone every 3 years 1, 2, 3
• Women with HPV-negative ASC-US results should return for screening in 3 years 1

Women Older Than 65

• Discontinue screening if:
  • 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the past 10 years 1, 2
  • Most recent test occurred within the last 5 years 1
  • No history of CIN2+ within the past 25 years 2
• Once screening is discontinued, it should not resume for any reason, including having a new sexual partner 1

Special Populations

• Women with HIV, immunocompromised status, in utero DES exposure, or history of cervical cancer:

  • Continue screening beyond age 65 2
  • Require individualized follow-up protocols 2

• Post-hysterectomy:

  • Women who have had a total hysterectomy (with removal of cervix) for benign disease do not need screening 2
  • Women who have had a subtotal (supracervical) hysterectomy should continue routine screening 2
  • After treatment for CIN2/3, continue screening for at least 20 years (even if extending past age 65) 1

Management of Abnormal Results

• Follow the 2019 ASCCP risk-based management consensus guidelines 2
• More conservative management is recommended for young women aged 21-24 years 2
• CIN1 should not be treated unless persistent for 2 years 2

Important Considerations

• Annual screening is NOT recommended for any age group 1, 2

  • Annual screening provides minimal additional cancer prevention but substantially increases unnecessary procedures 1
  • Screening every 3 years with cytology provides the best balance of benefits and harms 1

• HPV vaccination status does NOT change screening recommendations 1, 2

• Pregnancy or recent childbirth is NOT an indication to perform cervical cancer screening earlier than recommended 2

Screening Trends and Compliance

• Screening rates have been declining over time in all age groups 4, 5, 6
• Approximately 14 million women aged 21-65 in the US have not been screened within the past 3 years 4
• Lower screening rates are observed among recent immigrants, women without insurance, and women without a usual source of healthcare 4
• Despite recommendations against annual screening, many women continue to be screened annually 7

Benefits vs. Harms of Screening

• Benefits: Substantial reduction in cervical cancer incidence and mortality 2, 3
• Harms: Unnecessary procedures and treatments due to detection of transient HPV infections and lesions that would likely regress spontaneously 1
• Screening every 3 years is associated with approximately 760 colposcopies per 1000 women over a lifetime, while annual screening nearly triples this number to about 2000 colposcopies per 1000 women 1

By following these evidence-based guidelines, clinicians can maximize the benefits of cervical cancer screening while minimizing potential harms from overscreening and unnecessary interventions.