Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.

Abstract

The purpose of this best practice advice article is to describe the indications for screening for cervical cancer in asymptomatic, average-risk women aged 21 years or older. The evidence reviewed in this work is a distillation of relevant publications (including systematic reviews) used to support current guidelines. Clinicians should not screen average-risk women younger than 21 years for cervical cancer. Clinicians should start screening average-risk women for cervical cancer at age 21 years once every 3 years with cytology (cytologic tests without human papillomavirus [HPV] tests). Clinicians should not screen average-risk women for cervical cancer with cytology more often than once every 3 years. Clinicians may use a combination of cytology and HPV testing once every 5 years in average-risk women aged 30 years or older who prefer screening less often than every 3 years. Clinicians should not perform HPV testing in average-risk women younger than 30 years. Clinicians should stop screening average-risk women older than 65 years for cervical cancer if they have had 3 consecutive negative cytology results or 2 consecutive negative cytology plus HPV test results within 10 years, with the most recent test performed within 5 years. Clinicians should not screen average-risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix.