Cervical Cancer: Screening

  1. Annual Paps to begin after first sexual activity and/or after age 18.
  2. Test every 1-2 years until age 30.(Some recommend that after three normal Paps, screening can be every 2-3 years after age of 30 as the squamous metaplasia are – the substrate for neoplasia- is diminished in most women in their 30s). If an older woman’s sexual practices change, consider restarting more frequent screening.
  3. Consider discontinuing Pap tests after age 65-70 in well screened women with no history of significant dysplasia. Evidence does not support a specific age to stop screening. Restart screening if sexual practices change to more frequency.
  4. Consider discontinuing Pap testing in women whose uterus and cervix have been removed and who have no history of high-grade cervical dysplasia or cancer (Consider screening vaginal cuff and walls for vaginal dysplasia every 1 to 2 years.)
  5. Continue annual Pap testing in women with a history of cervical cancer in utero exposure to DES (diethylstilbestrol) or who are immunocompromised.
  6. Screening will continue long after the advent of multivalent HPV vaccines to prevent the 30% of cancers linked to high-risk HPV types that are not in the vaccine, to protect the previously HPV-infected.
  7. HPV 16/18 testing may permit less aggressive management of women with other high-risk HPV infection.A single positive test for HPV 16/18 is twice as likely as an LSIL Pap to identify women at high risk for CIN 3+.
    Women with ASCUS who are HPV DNA-positive and women with LSIL have the same risk of having high-grade disease and should therefore be managed identically. When citology is negative and HPV positive, repeat both tests in 6-12 months.

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