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National Guideline Clearinghouse | Guideline Synthesis: Screening for Cervical Cancer in Women at Average Risk

National Guideline Clearinghouse | Guideline Synthesis: Screening for Cervical Cancer in Women at Average Risk

National Guideline Clearinghouse (NGC)

January 13, 2014


Screening for Cervical Cancer in Women at Average Risk

Guidelines Being Compared:
  1. American College of Obstetricians and Gynecologists (ACOG)Screening for cervical cancer. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2012 Nov. 17 p. (ACOG practice bulletin; no. 131). [111 references]
  2. American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP)American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012 May;62(3):147-72. [158 references]
  3. U.S. Preventive Services Task Force (USPSTF)Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012 Jun 19;156(12):880-91. [46 references]
A direct comparison of the recommendations presented in the above guidelines for cervical cancer screening in average-risk, asymptomatic women is provided in the tables below. The routine screening recommendations presented herein apply to the general population and do not address high-risk populations such as women with a history of cervical cancer, women who were exposed to diethylstilbestrol (DES) in utero, and women who are immunocompromised (e.g., who are HIV positive). Recommendations for screening in women at increased risk of cervical cancer as well as recommendations for management of abnormal cytology results are beyond the scope of this synthesis.

Areas of Agreement

Age to Begin Screening
All of the guideline developers agree that cervical cancer screening should begin at age 21 and that women younger than age 21 should not be screened, regardless of the age of sexual initiation or the presence of other behavior-related risk factors.
Women Aged 21 to 29 Years
There is consensus among all of the guideline developers that women aged 21 to 29 years should be screened with cytology (liquid-based or conventional) alone every 3 years. All of the guideline developers recommend against screening using HPV testing in this age group, either as a standalone test or as a co-test with cytology.
Women Aged 30 to 65 Years
All of the developers address two primary screening strategies for use in this population: cytology alone and co-testing (cytology and HPV testing). While screening with cytology alone every 3 years is cited as an acceptable option by all of the guideline developers, ACOG and ACS/ASCCP/ASCP agree that co-testing every 5 years is preferred in this population. The USPSTF does not indicate a preference between the strategies; rather it considers co-testing every 5 years a "reasonable alternative" for women in this age group who would prefer to extend the screening interval, as this method offers a balance of benefits and harms comparable to screening with cytology alone every 3 years.
Discontinuation of Screening
The guideline developers agree that screening should be discontinued in women older than age 65 years who have had adequate prior screening and no history (ACS/ASCCP/ASCP specifies within the last 20 years) of CIN 2 or higher. ACOG and ACS/ASCCP/ASCP define negative prior screening as three consecutive negative cytology results or two consecutive negative co-test results within the previous 10 years, with the most recent test performed within the past 5 years. USPSTF supports this definition; they recommend following established guidelines for determining whether criteria for adequate prior testing are met and cite the ACS/ASCCP/ASCP definition specifically.
Screening after Hysterectomy
The guideline developers agree that screening for cervical cancer using any modality should be discontinued in women of any age who have had a total hysterectomy and who have no history of CIN 2 or higher.

Areas of Difference

There are no significant areas of difference between the guidelines.

Internet citation: National Guideline Clearinghouse (NGC). Guideline synthesis: Screening for cervical cancer. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2005 Oct (revised 2013 Mar) [cited YYYY Mon DD]. Available: http://www.guideline.gov.

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