From the Guidelines
Pap screening guidelines recommend that women begin cervical cancer screening at age 21, regardless of sexual history, with a Pap test every 3 years from ages 21-29, and then either a Pap test every 3 years, HPV testing alone every 5 years, or co-testing with both Pap and HPV tests every 5 years from ages 30-65. The guidelines aim to balance early detection of cervical abnormalities with avoiding unnecessary procedures for transient HPV infections that would likely resolve on their own 1.
Key Recommendations
- Women younger than 21 years should not be screened regardless of their age of sexual initiation 1
- Women at any age should not be screened annually by any screening method 1
- For women ages 30 to 65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing, although it is also acceptable for women to continue to be screened every 3 years with cytology alone 1
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening, with the most recent test occurring within the last 5 years 1
Rationale
Regular screening is crucial because cervical cancer develops slowly, and detecting precancerous changes early allows for effective treatment before cancer develops 1. The guidelines are based on a systematic evidence review and use a collaborative process that included multiple organizations 1.
Special Considerations
- Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons can discontinue screening 1
- Those with a history of cervical precancer should continue screening for at least 25 years, even if it extends beyond age 65 1
From the Research
Pap Screening Guidelines
- 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 is done by testing for human papillomavirus (HPV), which is the cause of almost all cervical cancers 3.
- HPV testing is 90% sensitive for detecting precancer, and the risk of precancer is less than 0.15% over 5 years following a negative HPV test result 2.
- For people with a positive HPV test result, a combination of HPV genotyping and cervical cytology (Papanicolaou testing) can identify the risk of precancer 2.
- The frequency of screening depends on the risk of precancer, with repeat HPV testing recommended in 1,3, or 5 years depending on the 5-year precancer risk 2.
Screening Recommendations
- People with a cervix should be screened with 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.
- For people with current precancer risks of less than 4%, repeat HPV testing is recommended in 1,3, or 5 years depending on the 5-year precancer risk 2.
- For people with current precancer risks of 4% through 24%, colposcopy is recommended 2.
- For patients with precancer risks of 25% or more, management consists of colposcopy with biopsy or excisional treatment 2.
Vaccination and Prevention
- HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers 2.
- The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 4.
- Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex, and a two-dose series is recommended if administered before 15 years of age 4.