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

From the Guidelines

HPV screening guidelines for women recommend regular testing to detect human papillomavirus, which can cause cervical cancer, with the preferred approach being primary HPV testing every 5 years for women aged 30 to 65 years, as recommended by the USPSTF in 2018 1.

Key Recommendations

• Women should begin screening at age 21 years with a Pap test every 3 years, as HPV testing is not recommended for women under 30 years old 1.
• Between ages 30-65, primary HPV testing every 5 years, HPV/Pap cotesting every 5 years, or Pap testing every 3 years are acceptable alternatives 1.
• Women over 65 who have had adequate prior screening with normal results can discontinue screening, as recommended by the USPSTF 1.
• Those who have had a total hysterectomy (including cervix removal) for non-cancerous reasons can also stop screening, unless they have a history of cervical precancer 1.

Rationale

• HPV screening is crucial because the virus causes nearly all cervical cancers, and detecting high-risk HPV types or abnormal cells early allows for monitoring or treatment before cancer develops 1.
• The longer screening intervals with HPV testing reflect its greater sensitivity in detecting precancerous changes compared to Pap tests alone 1.

Special Considerations

• Women with a history of cervical precancer should continue screening for at least 20 years, even if this extends beyond age 65, as recommended by the USPSTF 1.
• Women who have had their cervix removed should not be screened unless they have a history of CIN2 or more severe diagnosis (≥CIN2) 1.

From the Research

HPV Screening Guidelines for Women

• The US Preventive Services Task Force (USPSTF) recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years 2.
• For women aged 30 to 65 years, the USPSTF recommends screening 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 (cotesting) 2.
• The USPSTF recommends against screening for cervical cancer in women younger than 21 years, women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, and women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer 2.
• A study found that Pap testing practices for young women have been moving toward the latest guidelines, but more effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening 3.
• The Pap smear test is a highly useful, easy, technically safe, and cost-effective tool for detecting cervical epithelial precancerous lesions, and can be used as a routine screening technique for better treatment outcomes and reducing mortality rates 4.
• A majority of women are aware that screening recommendations have changed, yet many still believe women should be screened annually, and are concerned about HPV testing and extension of screening intervals to once every 5 years 5.
• Persistent infection with human papillomavirus (HPV) is recognized as the main risk factor of cervical cancer, and women with persistent HPV infection and normal cytology have an increased risk of CIN2+ 6.

Screening Intervals and Methods

• The USPSTF recommends screening 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 (cotesting) in women aged 30 to 65 years 2.
• A study found that women are willing to adopt a cervical cancer screening strategy of cytology alone or Pap-HPV cotesting every 3 years if recommended by their physician, but are concerned about HPV testing and extension of screening intervals to once every 5 years 5.
• The Pap smear test can be used as a routine screening technique for better treatment outcomes and reducing mortality rates, and the power of detection of precancerous lesions can be potentiated when using the Pap test and HPV-PCR test together 4.

Special Considerations

• Women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer do not need to be screened for cervical cancer 2.
• Women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer do not need to be screened for cervical cancer 2.
• Women with persistent HPV infection and normal cytology have an increased risk of CIN2+, and should be monitored closely 6.