Cervical Cancer Screening Guidelines

Cytologic screening (Papanicolaou or Pap smears) represents one of the most successful screening efforts of modern medicine. The morbidity and mortality secondary to cervical cancer has substantially decreased in adequately screened populations. Patients, however, need to understand that Pap smears are intended to be a screening, not a diagnostic, test. For any screening test there is an inherent false negative rate, which is approximately 10 to 20 percent for Pap smears.

Despite the false negative tests, the success of the cervical cytology screening program has led patients to expect 100 percent accuracy. Women need to understand that because of the screening nature of Pap smears, successful screening requires multiple repeat examinations and a minimization of risk factors that increase the chances of developing cervical cancer. These risk factors include sexual behaviors that can lead to infection with the human papillomavirus (HPV), certain strains of which can cause cervical cancer.

Recommendations for cervical cancer screening

For low risk patients:

• Cervical cancer screening should begin at age 21 years regardless of sexual history.
• For women aged 21 to 29 years, cervical cytology screening is recommended every three years.
• For women 30 years and older, who have had 3 consecutive negative Pap tests, are HPV negative, and have no history of CIN 2 (cervical intraepithelial neoplasia 2) or CIN 3 (cervical intraepithelial neoplasia 3), HIV, immunocompromised state or DES exposure in utero, the recommended screening interval may be extended to every five years after you have had a normal Pap smear and a negative HPV DNA test (or every three years with Reflex Pap).
• Routine cytology testing should be discontinued in women who have had a total hysterectomy for benign conditions and who have no history of high-grade CIN (cervical intraepithelial neoplasia).
• Cervical cancer screening can be discontinued between the ages of 65 and 70 years in women who have 3 or more consecutive negative cytology test results and no abnormal test results in the past 10 years.

For increased-risk patients:

• Annual Pap smear
• Annual pelvic exam

Increased risk is defined by the presence of any one of the following:

• Infection with certain high-risk strains of HPV
• HIV positive
• Cigarette smoking
• Multiple sexual partners
• Prior abnormal Pap smear or cervical dysplasia