From the Guidelines
For a 42-year-old female with a normal Pap smear and negative HPV test, her next cervical cancer screening should be in 5 years. This recommendation is based on the most recent guidelines from the American Cancer Society, as outlined in the 2019 review of current guidelines and issues in cancer screening 1. The preferred approach for women aged 30-65 years is to be screened every 5 years with the combination of HPV testing and cytology (“cotesting”), or every 3 years with cytology alone. Since the patient is 42 years old and has a normal Pap smear and negative HPV test, the 5-year interval is appropriate. This extended interval is supported by the fact that co-testing with both Pap and HPV provides greater reassurance against cervical cancer risk than either test alone. The negative HPV result is particularly significant since HPV is the causative agent in nearly all cervical cancers, and a negative result indicates very low risk.
The guidelines also emphasize that women should not be screened annually by any screening method, and that screening decisions should be individualized based on patient preferences, life expectancy, health status, and prior screening history. In this case, the patient's normal Pap smear and negative HPV test results support the 5-year screening interval. It is also important to note that the patient should still attend regular gynecological check-ups for other aspects of women's health care, and should report any abnormal vaginal bleeding, discharge, or pelvic pain promptly rather than waiting for her next scheduled screening.
Key points to consider in this patient's care include:
- The patient's age and screening history
- The results of her previous Pap smear and HPV test
- The absence of any immunocompromising conditions or history of cervical cancer or precancerous lesions
- The importance of regular gynecological check-ups and prompt reporting of any abnormal symptoms. As outlined in the guidelines, the 5-year screening interval is supported by the evidence, and is the recommended approach for women in this age group with normal screening results 1.
From the Research
Screening Guidelines
- According to the study 2, guidelines recommend screening for cervical cancer among women 30 years or older 3 years after a normal Papanicolaou test (Pap test) result or a combined normal screening result (normal Pap/negative human papillomavirus [HPV] test results).
- The study 3 also mentions that major organizations recommend cytology screening (Pap test) every 3 years for women aged 21-65, and women aged 30 to 65 have the option of adding the HPV test (co-test) every 5 years.
Screening Intervals
- The study 2 found that among Pap test providers who recommend HPV testing, 31.8% reported that they would conduct the next Pap test in 3 years for a 35-year-old woman with 3 normal Pap test results.
- For a 35-year-old woman with a normal Pap test result and a negative HPV test finding, only 19.0% would conduct the next Pap test in 3 years, as reported in the study 2.
- The study 4 found that screening intervals following a dual-negative cotest increased from 1.5 years in 2006/2007 to 2.5 years in 2010, coincident with increases in the proportion of women cotested.