From the Guidelines
For this 57-year-old female with a history of HPV positivity followed by two consecutive negative HPV and cytology co-tests, her next cervical cancer screening should be performed in 5 years, in 2030. This recommendation is based on her age and her recent negative screening history, as per the American Cancer Society's 2020 guideline update 1. After two consecutive negative co-tests (HPV and cytology), the risk of developing cervical cancer is very low, allowing for extended screening intervals. The natural history of cervical cancer typically involves persistent HPV infection over many years before progressing to precancerous lesions and eventually invasive cancer. Since she has demonstrated clearance of her previous HPV infection with two negative co-tests, her risk profile has significantly improved. Some key points to consider in this case include:
- The American Cancer Society recommends primary HPV testing every 5 years through age 65 years for individuals with a cervix 1.
- 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 1.
- The guideline also recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening 1. It's essential to note that if she develops any concerning symptoms such as abnormal vaginal bleeding, pelvic pain, or abnormal discharge before her next scheduled screening, she should seek medical evaluation promptly rather than waiting for her routine screening appointment.
From the Research
Cervical Cancer Screening Guidelines
The patient in question is a 57-year-old female with a history of positive HPV on routine cervical cancer screening, but subsequent screenings in 2021,2022, and 2025 were negative for HPV and cytology.
- The US Preventive Services Task Force recommends cervical cancer screening every 5 years using high-risk human papillomavirus (HPV) testing 2.
- A study published in the Cochrane database of systematic reviews found that HPV testing has a higher sensitivity than cytological testing for detecting cervical intraepithelial neoplasias (CIN) of grade 2 or worse 3.
- Another study published in the American journal of obstetrics and gynecology found that women who tested negative for HPV had the lowest 1-year cumulative risk for CIN grade 3 or worse 4.
Screening Interval
Based on the patient's history and current screening results, the next screening can be performed in 5 years, as per the US Preventive Services Task Force recommendations 2.
- The patient's negative HPV and cytology results in 2021,2022, and 2025 suggest a low risk of cervical cancer.
- The study published in the Cochrane database of systematic reviews found that a negative HPV test is more reassuring than a negative cytological test, as it has a lower chance of being falsely negative 3.
Conclusion is not allowed, so the response will be
Next Steps
The patient should be screened again in 5 years, or as recommended by her healthcare provider, based on her individual risk factors and medical history.
- It is essential to continue monitoring the patient's HPV and cytology results to ensure early detection and treatment of any potential cervical abnormalities.
- The patient's healthcare provider may also consider other factors, such as her age, medical history, and lifestyle, when determining the best screening schedule for her 5, 4, 6.