What are the guidelines for cervical cancer screening?

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 screening options include primary HPV testing alone every 5 years, cytology alone every 3 years, or co-testing every 5 years 1. Screening can be discontinued after age 65 if there is a history of adequate negative screening results and no history of high-grade precancerous lesions. Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons generally don't need screening. Those with a history of cervical cancer or high-grade precancerous lesions should continue screening for at least 20 years after treatment, even if this extends beyond age 65. HPV vaccination status does not change screening recommendations.

The American Cancer Society guidelines, updated in 2020, recommend primary HPV testing alone every 5 years as the preferred method for women aged 25-65, with cytology alone every 3 years or co-testing every 5 years as acceptable alternatives 1. The US Preventive Services Task Force (USPSTF) also recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21-29 years, and every 3 years with cervical cytology alone, every 5 years with high-risk HPV (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (co-testing) for women aged 30-65 years 1.

Key points to consider when implementing these guidelines include:

• Starting age: 25 years
• Screening options: primary HPV testing alone every 5 years, cytology alone every 3 years, or co-testing every 5 years
• Discontinuation of screening: after age 65 with adequate negative prior screening results and no history of high-grade precancerous lesions
• HPV vaccination status: does not change screening recommendations
• History of cervical cancer or high-grade precancerous lesions: continue screening for at least 20 years after treatment, even if this extends beyond age 65.

These guidelines aim to detect precancerous changes early when treatment is most effective while avoiding unnecessary procedures in low-risk individuals, as supported by the most recent evidence from the American Cancer Society 1.

From the Research

Cervical Cancer Screening Guidelines

• The US Preventive Services Task Force recommends cervical cytology screening once every 3 years for women between 21 and 29 years old, and advises against testing women younger than 21 years regardless of sexual history 2.
• A study found that the implementation of these guidelines did not have a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women, but further monitoring is needed for 26- to 29-year-old women 2.
• Primary care clinicians should offer HPV vaccination to all patients between the ages of nine and 26, in addition to cervical cancer screening and follow-up guidance 3.
• Clinicians should recognize the degrees of risk of high-grade CIN and cancer conferred by cytology, HPV subtype, and persistence of HPV infection, and address modifiable risk factors such as tobacco use 3.
• The 2019 ASCCP guidelines provide recommendations for the management of abnormal cervical cancer screening results, including surveillance and follow-up for patients with a history of abnormal screening results 3.

Screening and Diagnostic Procedures

• Colposcopy is a diagnostic procedure used 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 3.
• Pap smears, colposcopy, and biopsy are essential tools in the detection and diagnosis of cervical cancer, and their integration with other treatment options is crucial for effective management 4.
• Surgical techniques, such as radical hysterectomy and minimally invasive procedures, have advanced to enhance patient outcomes and quality of life, and radiation therapy methods have been refined to maximize tumor control while reducing adverse effects 4.

Treatment Options

• Immunotherapy, notably immune checkpoint inhibitors, has shown promise in advanced stages of cervical cancer, and targeted therapies that focus on specific biochemical pathways offer the potential for personalized treatment approaches 4.
• Chemotherapy remains vital, with new drugs and combination regimens demonstrating improved tolerance and efficacy, and surgery is an essential treatment option for cervical cancer, with advancements in techniques and technologies 4.