What are the guidelines for Pap smear screening for Human Papillomavirus (HPV)?

From the Guidelines

Pap screening for HPV should begin at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years. This is based on the most recent guidelines from the American Cancer Society, which recommends primary HPV testing as the preferred screening strategy for individuals with a cervix at average risk 1. The guidelines also state that if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years.

Some key points to consider when implementing these guidelines include:

• The recommended age to start screening is 25 years, rather than 21 years, as previously recommended
• Primary HPV testing is recommended starting at age 25 years, rather than age 30 years
• Screening can be discontinued after age 65 if there is no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and if there is documented adequate negative prior screening in the prior 10 years 1
• HPV vaccination status does not change screening recommendations, and individuals who have been vaccinated against HPV should still follow the same screening guidelines as those who have not been vaccinated

It's also important to note that these guidelines are intended to balance the benefits of detecting cervical abnormalities early against the risks of overscreening, which can lead to unnecessary procedures, anxiety, and potential harm from false positives. By following these guidelines, healthcare providers can help ensure that individuals with a cervix receive appropriate screening for HPV and cervical cancer, while minimizing the risks associated with overscreening 1.

From the Research

Pap Screening Guidelines for HPV

• The guidelines for Pap screening for HPV vary based on age and other factors 2, 3, 4, 5, 6.
• For women aged 21-29 years, HPV testing should not be used as a stand-alone test or as a co-test with cytology, except in the diagnosis of ASCUS 2.
• Women aged 30-65 years should be screened with cytology and HPV testing every 5 years or cytology alone every 3 years 2, 3.
• For women with a DNA HPV HR positive result and a negative Pap test, two options are recommended:
  • 12-month follow-up with co-testing (Pap and DNA HPV HR tests)
  • Test for HPV16 or HPV16/18 genotypes, and refer to colposcopy if positive 2.
• Women aged >65 years should not be screened following adequate negative prior screening, unless they have a history of CIN2 or a more severe diagnosis 2, 3.
• Women who have been vaccinated against HPV should follow age-specific recommendations, the same as unvaccinated women 2.
• The US Preventive Services Task Force recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology in women aged 30 to 65 years 3.

Requirements for DNA HPV HR Tests

• The DNA HPV tests used in cervical screening should detect as many as possible of the 14 HPV HR types and genotyping HPV 16/18 2.
• The tests should have control of DNA HPV purification and amplification processes and be preserved against contaminations 2.
• Clinical sensitivity for CIN 2+ should be no less than 90% 2.

Screening Trends and Outcomes

• Screening women for cervical cancer can save lives, but too-frequent screening can lead to high costs and adverse events associated with overtreatment 4.
• The 5-year risk of CIN 3+ is lower among women aged 21 to 24 years than among women aged 25 to 29 years or 30 to 64 years 5.
• The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations 6.