Prevention and Early Detection of Cervical Cancer

Cervical cancer screening should begin at age 21 years. Women aged younger than 21 years should not be screened regardless of the age of sexual initiation or other risk factors. ()

For women aged 21 to 29 years, screening with cytology alone every 3 years is recommended. For women aged 21 to 29 years with 2 or more consecutive negative cytology results, there is insufficient evidence to support a longer screening interval (ie, more than 3 years).
HPV testing should not be used to screen women in this age group, either as a stand-alone test or as a cotest with cytology. ()

Women aged 30 to 65 years should be screened with cytology and HPV testing (“cotesting”) every 5 years (preferred) or cytology alone every 3 years (acceptable). There is insufficient evidence to change screening intervals in this age group following a history of negative screens. ()

Women cotesting HPV positive, cytology negative should be followed with either (as noted in the interim ASCCP guidelines): Option 1) repeat cotesting in 12 months or Option 2) immediate HPV genotype‐specific testing for HPV16 alone or for HPV16/18. If cotesting is repeated at 12 months, women testing positive on either test (HPV positive or LSIL or more severe cytology) should be referred to colposcopy; women testing negative on both tests (HPV‐negative and ASC‐US or negative cytology) should return to routine screening. If immediate HPV genotype‐specific testing is used, women testing positive for HPV16 or HPV16/18 should be referred directly to colposcopy; women testing negative for HPV16 or HPV16/18 should be cotested in 12 months, with management of results as described in option 1. Women cotesting HPV positive, cytology negative should not be referred directly to colposcopy. Furthermore, they should not be tested for individual HPV genotypes other than HPV16 and HPV18. The use of HPV genotype‐specific testing for HPV16 or HPV16/18 is recommended only for the management of HPV‐positive, cytology‐negative women. Currently, there is insufficient evidence to support the use of non‐HPV biomarkers. ()

Women with ASC‐US cytology and a negative HPV test result should continue with routine screening as per age‐specific guidelines.

()

In most clinical settings, women aged 30 years to 65 years should not be screened with HPV testing alone as an alternative to cotesting at 5‐year intervals or cytology alone at 3‐year intervals. ()

Women aged older than 65 years with evidence of adequate negative prior screening and no history of CIN2+ within the last 20 years should not be screened for cervical cancer with any modality (adequate negative prior screening is defined as 3 consecutive negative cytology results or 2 consecutive negative cotests within the 10 years before ceasing screening, with the most recent test occurring within the past 5 years). Once screening is discontinued it should not resume for any reason, even if a woman reports having a new sexual partner. ()

Following spontaneous regression or appropriate management of CIN2, CIN3, or adenocarcinoma in situ, routine screening should continue for at least 20 years (even if this extends screening past age 65 years). ()

Women at any age following a hysterectomy with removal of the cervix who have no history of CIN2+ should not be screened for vaginal cancer using any modality. Evidence of adequate negative prior screening is not required. Once screening is discontinued, it should not resume for any reason, including a woman's report of having a new sexual partner. ()

Recommended screening practices should not change on the basis of HPV vaccination status.