From the Guidelines
Cervical cancer screening should begin at age 25 for women with a cervix, with primary HPV testing alone every 5 years as the preferred method, although cytology alone every 3 years or co-testing every 5 years are also acceptable options. For women aged 25-65, the preferred screening approach is primary HPV testing alone every 5 years, but cytology alone every 3 years or co-testing every 5 years are also acceptable alternatives 1. Women under 25 years old should not be screened, and those over 65 years old can discontinue screening if they have had adequate negative prior screening results and no history of high-grade precancerous lesions or cervical cancer. Women who have had a total hysterectomy with removal of the cervix and no history of high-grade precancerous lesions or cervical cancer do not need screening. These recommendations aim to balance the benefits of early detection with the potential harms of over-screening and over-treatment, and are based on the most recent evidence from the American Cancer Society and other reputable organizations 1.
Some key points to consider when implementing these recommendations include:
- The importance of using FDA-approved HPV tests for primary screening
- The need for adequate counseling and education for women about the benefits and risks of screening
- The importance of following up abnormal screening results with appropriate diagnostic testing and treatment
- The need for ongoing monitoring and evaluation of the effectiveness of these screening recommendations in preventing cervical cancer and reducing mortality.
It's worth noting that these recommendations may be updated as new evidence emerges, and that individual circumstances may require deviation from these guidelines. However, based on the current evidence, primary HPV testing alone every 5 years is the preferred method for cervical cancer screening in women aged 25-65 1.
From the Research
Cervical Cancer Screening Recommendations
- The US Preventive Services Task Force recommends cervical cancer screening for people with a cervix aged 21 through 65 years 2.
- Screening for cervical cancer can be done through HPV testing, and if HPV-positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment 2.
- HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers 2.
Screening Strategies
- A study compared stand-alone HPV testing with cotesting strategies, including conventional Pap smear test and liquid-based cytology, and found that HPV stand-alone screening offers a better balance of benefits and harms than cotesting 3.
- Another study found that cotesting demonstrated higher sensitivities, but at the cost of lower specificities compared with HPV stand-alone and cytology 3.
Colposcopy
- Colposcopy is a diagnostic procedure to evaluate for vaginal, vulvar, and cervical dysplasia, and its practice has evolved to incorporate patient risk factors for high-grade cervical intraepithelial neoplasia (CIN) and cancer 4.
- A study found that colposcopy had higher accuracy, sensitivity, specificity, and negative predictive values than the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervical intraepithelial neoplasia: CIN ≥ 2) in patients with secondary immunodeficiency 5.
Risk Assessment
- Primary care clinicians should recognize the degrees of risk of high-grade CIN and cancer conferred by cytology, HPV subtype, and persistence of HPV infection 4.
- Clinicians should address modifiable risk factors such as tobacco use, and provide counseling to patients about colposcopy based on their individual risks 4.
- Patients with an abnormal cervical cancer screening history require surveillance, which differs from routine screening for patients with normal prior screening results 4.