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Cervical
Cancer Screening and Prevention
Obstet Gynecol; 2016 Oct; ACOG Committee on Practice
Bulletins
October 10, 2016
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 behaviour-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. |
