Guidelines for screening cervical cancer and abnormal cells of the cervix are regularly evaluated and updated, based on statistics and health data. Both liquid-based and the conventional pap smear slide methods of screening are acceptable, but the majority of current screening uses the liquid-based process. The liquid-based technology will filter out most of the blood and inflammatory cells and debris, and in addition, can be used for HPV testing as well as gonorrhea and chlamydia infections.
As of December 2009, the American College of Obstetricians and Gynecologists (ACOG) have updated their clinical guidelines as follows:
- Cervical cancer screening should begin at age 21 years. Screening before age 21 should be avoided because it may lead to unnecessary and harmful evaluation and treatment in women at very low risk of cancer.
- Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years
- Women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of moderate cervical dysplasia (CIN 2) or severe cervical dysplasia (CIN 3), are not HIV infected, are not immunocompromised, and were not exposed to DES in utero may extend the interval between cervical cytology exams to every 3 years.
- Both liquid-based and conventional methods of cervical cytology are acceptable for screening.
- In women who have had a total hysterectomy (all of uterus removed) for a benign indications (ex/ uterine fibroids, endometriosis, abnormal bleeding unrelated to cancer) and have no prior history of a moderate or severe dysplasia, routine cytology testing should be discontinued.
- Co-testing using the combination of cytology plus the HPV test is an appropriate screening test for women older than 30 years. Any low-risk woman aged 30 years or older who receives negative test results on the pap/liquid based pap screen and HPV test should be rescreened no sooner than 3 years subsequently.
- Sexually active adolescents (women younger than age 21) should be counseled and tested for sexually transmitted infections, and should be counseled regarding safe sex and contraception.
- It is reasonable to discontinue cervical cancer screening between 65 years and 70 years of age in women who have three or more negative cytology test results in a row and no abnormal test results in the past 10 years.
- Women treated for moderate or severe dysplasia or cervical cancer are at risk for persistent or recurrent disease for at least 20 years and should continue to have annual screening for at least 20 years.
- Women who have had a hysterectomy with a history of moderate or severe dysplasia should continue to be screened even after treatment.
- ANNUAL GYNECOLOGIC EXAMS ARE STILL APPROPRIATE, EVEN IF CERVICAL CYTOLOSY SCREENING IS NOT PERFORMED AT EACH VISIT.
- Women who have been immunized against HPV-16 and HPV-18 should be screened by the same regimens.
Commentary: These guidelines are regularly changed based on statistics on incidence of cervical dysplasias and cervical cancer, treatment outcomes, new information on the cause and progress of a disease, and the influence of cost effectiveness and benefits and risks of overtreatment and undertreatment. With the development of liquid based collection systems (ex/ Thin Prep and Sure Path), and the ability to test for low risk and high risk strains of HPV, this has led to some of the guidelines where the pap is needed less often, as long as the cytology and the HPV are negative. My main concern about this development is that many women, and even practitioners, interpret this to mean they do not still need an annual physical exam.
Source: ACOG practice bulletin Number 109, December 2009
