According to recent evidence-based recommendations published by the American College of Obstetricians and Gynecologists (ACOG), screening for cervical cancer should begin at age 21 and repeated less often than previously recommended. The three key changes from the existing guidelines include:

• Cervical cancer screening should begin at 21 years of age (regardless of sexual history). Screening before age 21 should be avoided because women < 21 years of age are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment.
• Cervical cytology screening is recommended every 2 years for women between the ages of 21 and 29 years of age, rather than every year. Evidence shows that screening women every year has little benefit over screening every other year.
• Women older than age 30 years can be rescreened once every 3 years if they have had 3 consecutive negative cervical cytology test results.

ACOG previously advised women to have an initial Pap test within 3 years of becoming sexually active or at age 21, whichever came first. The organization also recommended annual screening. According to ACOG, changing the baseline Pap test to age 21 reflects a desire to avoid unnecessary treatment of adolescents. Although infection with human papillomavirus (HPV) is common in sexually active adolescents and teenagers, HPV-induced cervical dysplasia in this age group usually resolves without treatment and cervical cancer rarely occurs in women younger than age 21. According to ACOG, screening for cervical cancer in adolescent girls has led to overuse of follow-up procedures for something that often resolves on its own. ACOG also recommends that women who have been vaccinated follow the same screening guidelines as unvaccinated women. In women who have had a total hysterectomy for benign indications and have no prior history of high-grade cervical intraepithelial neoplasia (CIN), routine cytology testing should be discontinued.

Although screening and early detection have made cervical cancer less of a threat in the West, it remains the second most common cancer in women worldwide and causes most cancer-related deaths among women in developing countries. Women with certain risk factors may require more frequent screening, including those who have HIV, are immunosuppressed, were exposed to diethylstilbestrol in utero, and have been treated for CIN 2, CIN 3, or cervical cancer.

1. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin. Cervical cytology screening. Number 109, December 2009. (Replaces Practice Bulletin Number 45, August 2003; Committee Opinion Number 300, October 2004; and Committee Opinion Number 431, May 2009). Obstet Gynecol. 2009;114:1409-1420. Available at: http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf. Accessed November 24, 2009.

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This entry was posted on Tuesday, November 24th, 2009 at 12:00 pm.