From the Guidelines
Pap screening for government healthcare programs should follow the current guidelines of starting at age 21 and continuing until age 65 for most women. For those aged 21-29, screening should occur every 3 years with cytology alone, as recommended by the American Cancer Society 1. Women 30-65 can be screened every 3 years with cytology alone or every 5 years with co-testing (cytology plus HPV testing), as both approaches are acceptable according to the 2012 joint guideline issued by the ACS, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology 1.
Key Recommendations
- Screening for cervical cancer should begin at age 21 years
- Women ages 21 to 29 years should receive cytology screening every 3 years
- For women ages 30 to 65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening, with the most recent test occurring within the last 5 years, as stated in the guideline 1.
Rationale
These recommendations are based on the understanding that cervical cancer develops slowly over time, and HPV infections often clear spontaneously, particularly in younger women 1. Government programs should ensure coverage for these evidence-based screening intervals, as they balance early detection of cervical abnormalities with avoiding overscreening and unnecessary procedures. Additionally, government programs should consider implementing HPV vaccination coverage as a preventive measure, as this addresses the primary cause of cervical cancer and can eventually reduce screening needs.
From the Research
Pap Screening for Government Programs
- The current guidelines for cervical cancer screening recommend Papanicolaou (Pap) testing every 3 years for women aged 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women aged 30-65 years 2.
- A study found that in 2016,64.6% of eligible 30- to 65-year-old women were up to date with cervical cancer screening, with 60.8% having received Pap-HPV cotest screening 2.
- However, the same study observed significant declines in Pap completion rates over time in all age groups, including an unexpected decline in 21- to 29-year-old women 2.
- Another study found that over half of the sample (55%) were willing to receive the HPV test instead of the Pap test, with significant motivating factors including positive attitudes, social norms, and perceived benefits 3.
- The study also found that women were significantly more willing to get the HPV test if a provider recommended it and if they were currently up-to-date on cervical cancer screening guidelines 3.
Comparison of Screening Strategies
- A study compared the sensitivity and specificity of conventional Pap smear test, liquid-based cytology, and human papillomavirus testing as stand-alone or cotesting strategies for cervical cancer screening 4.
- The study found that cotesting demonstrated higher sensitivities, but at the cost of lower specificities compared with HPV stand-alone and cytology 4.
- Another study compared the results of self-collected and physician-collected vaginal specimens for Pap and HPV testing, and found that self-collected Pap tests can provide a test result with a very high positive predictive value 5.
Integration of Screening and Treatment
- A review of the latest advancements and best practices in detection and intervention for cervical cancer highlighted the importance of integrating Pap smears, colposcopy, biopsy, immunotherapy, targeted therapies, chemotherapy, radiation therapy, and surgery 6.
- The review emphasized the opportunities and challenges of each therapeutic approach and the need for personalized treatment approaches 6.