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American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology |
U.S. Preventive Services Task Force (USPSTF)2 |
American College of Obstetricians and Gynecologists (ACOG)
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| When to start screening |
Age 21. Women aged <21 years 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 years (D recommendation) |
Age 21 regardless of the age of onset of sexual activity. Women aged <21 years should not be screened regardless of age at sexual initiation and other behavior-related risk factors (Level A evidence)
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| 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 years, 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
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| When to stop screening |
Aged >65 years with adequate negative prior screening* and no history of CIN2 or higher within the last 20 years |
Aged >65 years with adequate screening history* and are not otherwise at high risk for cervical cancer (D recommendation) |
Aged >65 years with adequate negative prior screening* results and no history of CIN 2 or higher (Level A evidence)
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| When to screen after age 65 years |
When to screen after age 65 years Aged >65 years with a history of CIN2 CIN2, CIN3, or adenocarcinoma in situ, routine screeningk should continue for at least 20 years |
Women aged >65 years 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.l Routine screeningk should continue for at least 20 years after spontaneous regression or appropriate management of a high-grade precancerous lesion, even if this extends screening past age 65 years. Certain considerations may support screening in women aged > 65 years who are otherwise considered high risk (such as women with a highgrade precancerous lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised) |
Women aged >65 years with a history of CIN2, CIN3, or AIS should continue routine agebased screeningk for at least 20 years (Level B evidence).
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| 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)
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| The need for a bimanual pelvic exam |
Not addressed in 2012 guidelines but was addressed in 2002 ACS guidelines |
Addressed in USPSTF ovarian cancer screening recommendations (draft) |
Addressed in 2012 well-woman visit recommendations.r Aged <21 years, no evidence supports the routine internal examination of the healthy, asymptomatic patient. An “external-only” genital examination is acceptable. Aged ≥21 years, 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
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| Screening among those immunized against HPV 16/18 |
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)
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