Cervical Cancer Screening Guidelines
Cytologic screening (Papanicolaou or Pap test) represents one of the most successful screening efforts of modern medicine. The death rates due to cervical cancer have substantially improved in adequately screened populations. As compared to the days when a yearly Pap test was done, the introduction of HPV testing along with a Pap test (co-testing) has revolutionized cervical cancer screening. This combination testing has led to less frequent testing, while maintaining the benefits of finding cancer or pre-cancer with similar—or often better—success. One additional benefit of the newer guidelines that incorporate co-testing (testing both Pap test and HPV) is fewer unnecessary treatments for mild Pap test abnormalities that have a very low likelihood of progressing to cancer. Such can lead to unnecessary patient anxiety, excessive medical costs, and potential problems with cervical stenosis (scarring of the cervix) and future pregnancy complications (related to early delivery and/or early rupture of membranes).
Recommendations for cervical cancer screening
National societies agree on the following recommendations:
Cervical cancer screening should begin at age 21 years regardless of sexual history.
For women aged 21 to 29 years, screening is recommended every 3 years with only a Pap test (no HPV test).
For women 30 years and older, co-testing with Pap and HPV should be done every 5 years or Pap test alone every 3 years
Routine Pap testing should be discontinued (stopped) in women who have had a total hysterectomy for benign conditions and who have no history of CIN (cervical intraepithelial neoplasia) grade 2 or higher.
Cervical cancer screening can be discontinued at age 65 in women who have 2 consecutive normal co-test results or 3 consecutive normal Pap test results in the past 10 years, with the most recent normal test performed in the past 5 years.
For women adequately treated for cervical intraepithelial neoplasia (CIN) grade 2 or higher, they will need to continue screening for 20 years, even if it takes them past the age of 65.
The above recommendations do NOT apply to women who have HIV, are immunocompromised (have a weak immune system), have a history of DES in utero exposure, and have not been adequately screened.
It is important to remember that a diagnostic Pap test may be done earlier if a woman is having new problems, such as unusual bleeding.
Also, women being followed for an abnormal Pap test or who have been treated for an abnormal Pap test will have a different scheduled follow-up than what is noted above.
Are routine pelvic exams necessary?
There is no consensus from national experts and medical societies about whether a woman needs a pelvic exam on the years that she is not due for cervical cancer screening. Some medical societies leave it up to the doctor and patient to decide whether a pelvic exam should be done, while other societies discourage a pelvic exam due to patient discomfort, and the potential for unnecessary follow-up for harmless findings. Unfortunately, a pelvic exam has never been shown to prevent cancer, especially for cancers that women worry about the most, such as ovarian cancer.
Young women age 25 and under who have engaged in sexual activity are recommended to have an annual (once yearly) screening test for chlamydia.
Thomas C. Wright Jr, MD; L. Stewart Massad, MD; Charles J. Dunton, MD; Mark Spitzer, MD; Edward J. Wilkinson, MD; Diane Solomon, MD, for the 2006 American Society for Colposcopy and Cervical Pathology–sponsored Consensus Conference. 2006 Consensus Guidelines for the management of Women with Abnormal Cervical Cancer Screening Tests. American Journal of Obstetrics and Gynecology; October 2007: 346-55.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012 Apr;137(4):516-42.
Danforth K, Im T, Whitlock E. Addendum to Screening for Ovarian Cancer: Evidence Update for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Release Date: April 2012
Well-woman visit. Committee Opinion No. 534. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:421–4.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/5/2014…#5641