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U.S. Preventive Services Task Force


Screening for Cervical Cancer

Clinical Summary of U.S. Preventive Services Task Force Recommendation

Release Date: March 2012

Population Women ages 21 to 65 Women ages
30 to 65
Women younger than age 21 Women older than age 65 who have had adequate prior screening and are not high risk Women after hysterectomy with removal of the cervix and with no history of high-grade precancer or cervical cancer Women younger than age 30
Recommendation Screen with cytology (Pap smear) every 3 years.
Grade: A
Screen with cytology every 3 years or co-testing (cytology/HPV testing) every 5 years.
Grade: A
Do not screen.
Grade: D
Do not screen.
Grade: D
Do not screen.
Grade: D
Do not screen with HPV testing (alone or with cytology).
Grade: D
Risk Assessment Human papillomavirus (HPV) infection is associated with nearly all cases of cervical cancer. Other factors that put a woman at increased risk of cervical cancer include HIV infection, a compromised immune system, in utero exposure to diethylstilbestrol, and previous treatment of a high-grade precancerous lesion or cervical cancer.
Screening Tests Screening women ages 21 to 65 years every 3 years with cytology provides a reasonable balance between benefits and harms.

Screening with cytology more often than every 3 years confers little additional benefit, with large increases in harms.

HPV testing combined with cytology (co-testing) every 5 years in women ages 30 to 65 years offers a comparable balance of benefits and harms, and is therefore a reasonable alternative for women in this age group who would prefer to extend the screening interval.

Timing of Screening Screening earlier than age 21 years, regardless of sexual history, leads to more harms than benefits. Clinicians and patients should base the decision to end screening on whether the patient meets the criteria for adequate prior testing and appropriate follow-up, per established guidelines.
Interventions Screening aims to identify high-grade precancerous cervical lesions to prevent development of cervical cancer and early-stage asymptomatic invasive cervical cancer.

High-grade lesions may be treated with ablative and excisional therapies, including cryotherapy, laser ablation, loop excision, and cold knife conization.

Early-stage cervical cancer may be treated with surgery (hysterectomy) or chemoradiation.

Balance of Harms and Benefits The benefits of screening with cytology every 3 years substantially outweigh the harms. The benefits of screening with co-testing (cytology/HPV testing) every 5 years outweigh the harms. The harms of screening earlier than age 21 years outweigh the benefits. The benefits of screening after age 65 years do not outweigh the potential harms. The harms of screening after hysterectomy outweigh the benefits. The potential harms of screening with HPV testing (alone or with cytology) outweigh the potential benefits.
Other Relevant USPSTF Recommendations The USPSTF has made recommendations on screening for breast cancer and ovarian cancer, as well as genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility. These recommendations are available at http://www.uspreventiveservicestaskforce.org/.

For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

AHRQ Publication No. 11-05156-EF-3
Current as of March 2012


Internet Citation:

Screening for Cervical Cancer: Clinical Summary of U.S. Preventive Services Task Force Recommendation. AHRQ Publication No. 11-05156-EF-3, March 2012. http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancersum.htm


 


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