Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Cervical Cancer Screening and Prevention

Obstet Gynecol; 2016 Oct; ACOG Committee on Practice Bulletins

The American College of Obstetricians and Gynecologists (ACOG) has issued an interim update to its practice bulletin on cervical cancer screening and prevention to include changes for screening in adolescents and young women infected with human immunodeficiency virus (HIV) or who are otherwise immunocompromised. Recommendations (Level A) and conclusions include:

  • Cervical cancer screening should begin at age 21 years. With the exception of women who are infected with HIV or who are otherwise immunocompromised, women younger than 21 years should not be screened regardless of the age of sexual initiation or the presence of other behavior-related risk factors.
  • Women aged 21 to 29 years should be tested with cervical cytology alone, and screening should be performed every 3 years. Cotesting should not be performed in women younger than 30 years. Annual screening should not be performed.
  • For women aged 30 to 65 years, cotesting with cytology and HPV testing every 5 years is preferred; screening with cytology alone every 3 years is acceptable. Annual screening should not be performed.
  • Screening by any modality should be discontinued after age 65 years in women with evidence of adequate negative prior screening test results and no history of CIN 2 or higher.
  • In women who have had a hysterectomy with removal of the cervix (total hysterectomy) and have never had CIN 2 or higher, routine cytology screening and HPV testing should be discontinued and not restarted for any reason.
  • Women with any of the following risk factors may require more frequent cervical cancer screening than recommended in the routine screening guidelines, which were intended for average-risk women:
    • Women who are infected with HIV.
    • Women who are immunocompromised (such as those who have received solid organ transplants).
    • Women who were exposed to diethylstilbestrol in utero.
    • Women previously treated for CIN 2, CIN 3, or cancer.

Citation:

Cervical cancer screening and prevention. Practice Bulletin No. 168. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;128:e111–30.