gynecology and obstetrics
Cervical Cancer Screening and Prevention
Screening for Cervical Cancer
Routine cervical cancer screening effectively detects preinvasive and early-stage disease and decreases cervical cancer incidence and mortality rates. Two types of screening tests for cervical abnormalities are used: Testing for high-risk HPV genotypes Pap test (cervical cytology) If Pap and HPV testing are not available (eg, in resource-limited settings), visual inspection of the cervix after application ofacetic acidor Lugol iodine is an alternative screening method. Cervical screening guidelines vary somewhat; general guidelines include (see table): 21 to 25 years: Starting age for screening 21 to 29 years: Options include Pap test alone every 3 years (preferred by the United States Preventive Services Task Force [USPSTF, Screening references ]); HPV test alone every 5 years (preferred by the American Cancer Society [ACS, 20 to 65 years: Options include Pap and HPV co-testing every 5 years (preferred by USPSTF); HPV test alone every 5 years (preferred by ACS); or Pap test alone every 3 years > 65 years: Testing is stopped if an adequate series of previous tests have been normal across the preceding 10 years; testing should be continued if women have not had adequate normal test results, or started if they have not been screened previously For patients screened with a Pap test alone, if the cytology result is ASCUS (atypical squamous cells of undetermined significance), which is an inconclusive finding, HPV testing is the preferred method of follow-up evaluation; this approach is called reflex HPV testing. If HPV testing is negative, screening tests should be repeated in 3 years. If HPV testing is positive, colposcopy should be done. For women who have had a total hysterectomy (cervix and uterus removed) and do not have a history of cervical cancer or high-grade cervical intraepithelial neoplasia, further screening is not indicated. The Papanicolaou test (cervical cytology) was developed in 1928 and was a major advancement in screening for cervical cancer. Cervical cytology results are reported using standardized terminology, the Bethesda System (see table). 1.US Preventive Services Task Force, Curry SJ, Krist AH, et al: Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674-686. doi:10.1001/jama.2018.10897 2.Fontham ETH, Wolf AMD, Church TR, et al: Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society.CA Cancer J Clin70(5):321-346, 2020. doi:10.3322/caac.21628 