Cervical Cancer: Screening
- Annual Paps to begin after first sexual activity and/or after age 18.
- 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.
- 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.
- 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.)
- Continue annual Pap testing in women with a history of cervical cancer in utero exposure to DES (diethylstilbestrol) or who are immunocompromised.
- 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.
- 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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