Cervical Cancer Screening in Women at Average Risk

The American College of Physicians (ACP) recently released advice for reducing the overuse of cervical cancer screening in women who do not have symptoms. The document, "Cervical Cancer Screening in Average-Risk Women," was published in Annals of Internal Medicine. Two concurring organizations are listed in the document: the American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology.

"ACP's advice for cervical cancer screening is designed to maximize the benefits and minimize the harms of testing," said David Fleming, MD, ACP president, in a prepared statement. "Historically, physicians have low adherence to cervical cancer screening recommendations, beginning screening too early, performing screening too often, and continuing to screen women at low risk, either by age criteria or after hysterectomy with removal of cervix."

The guidelines, largely in line with guidelines issued in 2012, move away from annual screening of average-risk women at any age. Clinicians should begin screening average-risk women at age 21, using cytology tests alone, and repeat it once every 3 years, ACP advises. For women age 30 and older at average risk, a combination of cytology and HPV testing once every 5 years is recommended for those who prefer screening less often than every 3 years. Screening can be stopped altogether for women older than 65 who have had three consecutive negative cytology tests or two consecutive negative cytology plus HPV tests within 10 years, as long as the most recent test is within the last 5 years.

Women younger than 21 should not be screened for cervical cancer, nor should women at average risk more often than every 3 years. HPV testing should not be performed in women younger than 30, and women who have had a hysterectomy with the cervix removed do not need screening.

In contrast, interim guidance issued in January with input from multiple medical associations suggested that primary HPV testing at 3-year intervals starting at age 25 was a reasonable alternative to cytology or co-testing for HPV. This document supported primary HPV testing, given evidence of HPV testing’s reproducibility and sensitivity for detecting precancerous lesions.