ACOG Releases New Clinical Management Guidelines for Cervical Cancer Screening

The American College of Obstetricians and Gynecologists released on November 20, 2009, a set of revised guidelines regarding screening for cervical cancer. The following is an overview of the updated guidelines and the rationale for the noted changes prepared by the Society of Gynecologic Oncology:

  • Initial Pap screening at age 21 (previous recommendation: by age 21 or three years after first intercourse). The risk of cervical cancer in women under age 20 is only about 1-2/million and recent British data suggests that those few cancers are ones that are not well-detected through screening. Most Pap abnormalities result from HPV infections that women will likely “clear” themselves. The diagnosis often results in stigmatization, disrupted relationships, and anxiety about a clinically irrelevant diagnosis. Treatment for these abnormalities, which may resolve without therapy, can raise the risk for these women who are in their reproductive prime of delivering infants preterm.
  • Screen every two years between 21 and 29. (previous recommendation: screen every year 21-29) Evidence shows that screening women every year has little benefit over screening every other year.
  • Screen only every three years between 30 and 65-70 in low risk women.
    • Women aged 30 years and older who have had three consecutive negative Pap test results and who are low risk (i.e., have no history of cervical precancerous lesions, are not infected with Human Immunodeficiency virus (HIV), are not immunocompromised, and were not exposed to diethylstilbestrol (DES) in utero) may extend the interval between Pap tests to every 3 years. As in adolescents, more frequent screening is likely to identify abnormalities that are not clinically relevant and will likely clear on their own.
    • Screen for women at high risk more frequently and as indicated.
    • Still continue to have an annual well-woman exam
  • Women treated in the past for cervical precancerous lesions or cancer -- continue annual screening for at least 20 years.
  • Consider stopping screening at age 65-70 for women with three or more consecutive, documented, negative Pap tests and no abnormal Pap tests within 10 years.
  • Liquid-based and conventional Pap ‘smears’ are similarly effective in preventing cervical cancer.
  • Cease screening after hysterectomy for documented benign disease. Continue to screen after hysterectomy for cervical precancerous lesions or cancer and those without documentation of any lesions.
  • If using co-testing (Pap + HPV test) for women over 30 years of age, only do so every three years if Pap negative and HPV negative. As noted previously, frequent testing just identifies abnormalities likely to regress over time. Also, the risk of developing a clinical relevant cervical lesion if Pap negative and HPV negative is extremely small within 3 years.

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