What are the co-testing recommendations for cervical cancer screening in women aged 30-65 using Pap (Papanicolau) test and HPV (Human Papillomavirus) test?

Co-Testing Recommendations for Cervical Cancer Screening in Women Aged 30-65

For women aged 30-65 years, co-testing with both Pap test and HPV test every 5 years is recommended as an effective screening strategy for cervical cancer, offering comparable benefits to cytology alone every 3 years. 1

Recommended Screening Approaches for Women 30-65 Years

• For women aged 30-65 years, three screening options are recommended:

  • Co-testing (Pap test + HPV test) every 5 years (preferred by some guidelines) 1, 2
  • Cytology (Pap test) alone every 3 years 1
  • HPV testing alone every 5 years 1, 2

• Co-testing provides higher sensitivity than Pap testing alone, allowing for the extended 5-year screening interval 1, 3

• The 5-year interval for co-testing is safe and effective, as a negative HPV test provides substantial reassurance against cervical cancer development over this timeframe 3

Benefits of Co-Testing

• Co-testing identifies women at high risk of cervical cancer earlier than cytology alone, especially for adenocarcinoma 3

• The 5-year cumulative incidence of cervical cancer is lower in women who test negative by both HPV and Pap testing (3.2 per 100,000) compared to those negative by Pap testing alone (7.5 per 100,000) 3

• Co-testing helps identify women with HPV positive/cytology negative results who may still be at risk for developing cervical cancer 4

Important Considerations and Caveats

• Co-testing is NOT recommended for women younger than 30 years due to:

  • High prevalence of HPV in young women 1
  • Poor specificity of co-testing in this age group 1
  • Limited clinical benefit compared to potential harms 1

• Geographic variations exist in co-testing uptake across the United States, with lower rates in Midwestern and Southern states (27.5-49.9%) compared to Northeastern states 5

• About one-third of women who are up to date on Pap testing report having had co-testing with their most recent Pap test 6

• Women who are HPV positive but have normal cytology (approximately 5% of screened women) represent a challenging management group 4

Special Populations

• The recommendations do NOT apply to:

  • Women who have received a diagnosis of high-grade precancerous cervical lesion or cervical cancer 1
  • Women with in utero exposure to diethylstilbestrol 1
  • Women who are immunocompromised (such as those with HIV) 1

• Women older than 65 years should discontinue screening if they have had adequate prior screening and are not otherwise at high risk 1

• Women who have had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions or cervical cancer should not undergo screening 1

Implementation Considerations

• Co-testing is a preventive service required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans 4

• Provider and patient education may be needed to clarify recommended use of HPV tests and appropriate screening intervals 6

• Approximately 14 million women aged 21-65 in the US have not been screened within the past 3 years, highlighting the need for improved screening rates overall 6