When to start screeningb | Age 21. Women aged <21 y should not be screened regardless of the age of sexual initiation or other risk factors. | Age 21 (A recommendation). Recommend against screening women aged <21 y (D recommendation). | Age 21 regardless of the age of onset of sexual activity. Women aged <21 y should not be screened regardless of age at sexual initiation and other behavior-related risk factors (Level A evidence). | Refer to major guidelines. |
Statement about annual screening | Women of any age should not be screened annually by any screening method. | Individuals and clinicians can use the annual Pap test screening visit as an opportunity to discuss other health problems and preventive measures. Individuals, clinicians, and health systems should seek effective ways to facilitate the receipt of recommended preventive services at intervals that are beneficial to the patient. Efforts also should be made to ensure that individuals are able to seek care for additional health concerns as they present. | In women aged 30–65 y annual cervical cancer screening should not be performed. (Level A evidence) Patients should be counseled that annual well-woman visits are recommended even if cervical cancer screening is not performed at each visit. | Not addressed. |
Screening method and intervals |
Cytology (conventional or liquid-based)c | |
21–29 y of age | Every 3 y.d | Every 3 y (A recommendation). | Every 3 y (Level A evidence). | Not addressed. |
30–65 y of age | Every 3 y.d | Every 3 y (A recommendation). | Every 3 y (Level A evidence). | Not addressed. |
HPV co-test (cytology + HPV test administered together) | |
21–29 y of age | HPV co-testing should not be used for women aged <30 y. | Recommend against HPV co-testing in women aged <30 y (D recommendation). | HPV co-testinge should not be performed in women aged <30 y (Level A evidence). | Not addressed. |
30–65 y of age | Every 5 y; this is the preferred method. | For women who want to extend their screening interval, HPV co-testing every 5 y is an option (A recommendation). | Every 5 y; this is the preferred method (Level A evidence). | Not addressed. |
Primary hrHPV testingf (as an alternative to co-testing or cytology alone)g | For women aged 30–65 y, screening by HPV testing alone is not recommended in most clinical settings.h | Every 5 y for women 30–65 y of age (A recommendation). | Alternative screening every 3 y for women ≥25 y as per SGO and ASCCP interim guidance (Level B evidence). | Every 3 y. Recommend against primary hrHPV screening in women aged <25 y of age.i |
| Aged >65 y with adequate negative prior screening* and no history of CIN2 or higher within the last 20 y.j | |
When to stop screening | *Adequate negative prior screening results are defined as 3 consecutive negative cytology results or 2 consecutive negative co-test results within the previous 10 y, with the most recent test performed within the past 5 y. | Aged >65 y with adequate screening history* and are not otherwise at high risk for cervical cancerj (D recommendation). | Aged >65 y with adequate negative prior screening* results and no history of CIN 2 or higherj (Level A evidence). | Not addressed. |
When to screen after age 65 y | Aged >65 y with a history of CIN2 CIN2, CIN3, or adenocarcinoma in situ, routine screeningl should continue for at least 20 y. | Women aged >65 y who have never been screened, do not meet the criteria for adequate prior screening, or for whom the adequacy of prior screening cannot be accurately accessed or documented.k Routine screeningl should continue for at least 20 y after spontaneous regression or appropriate management of a high-grade precancerous lesion, even if this extends screening past age 65 y. Certain considerations may support screening in women aged >65 y who are otherwise considered high risk (such as women with a high-grade precancerous lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised). | Women aged >65 y with a history of CIN2, CIN3, or AIS should continue routine age-based screeningl for at least 20 y (Level B evidence). | Not addressed. |
Screening post-hysterectomy | Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening.m Women who have had a supra-cervical hysterectomy (cervix intact) should continue screening according to guidelines. | Recommend against screening in women who have had a hysterectomy (removal of the cervix)n (D recommendation). | Women who have had a hysterectomy (removal of the cervix) should stop screening and not restart for any reasonn,o (Level A evidence). | Not addressed. |
The need for a bimanual pelvic exam | Not addressed in 2012 guidelines but was addressed in 2002 ACS guidelines.p | Addressed in USPSTF ovarian cancer screening recommendations (draft).q | Addressed in 2012 well-woman visit recommendations.r Aged <21 y, no evidence supports the routine internal examination of the healthy, asymptomatic patient. An “external-only” genital examination is acceptable. Aged ≥21 y, no evidence supports or refutes the annual pelvic examination or speculum and bimanual examination. The decision whether or not to perform a complete pelvic examination should be a shared decision after a discussion between the patient and her health care provider. Annual examination of the external genitalia should continue.s | Not addressed. |
Screening among those immunized with HPV vaccine | Women at any age with a history of HPV vaccination should be screened according to the age specific recommendations for the general population. | The possibility that vaccination might reduce the need for screening with cytology alone or in combination with HPV testing is not established. Given these uncertainties, women who have been vaccinated should continue to be screened. | Women who have received the HPV vaccine should be screened according to the same guidelines as women who have not been vaccinated (Level C evidence). | Not addressed. |