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recommendations for performing Papanicolaou (Pap) smear

Notes: American Cancer Society & American College of Obstetricians & Gynecologists 1) age 21 2) every 2 years until age 30, then every 3 years after 3 consecutive, technically satisfactory normal/negative cytology results [2] 3) women risk factors may require more frequent screenings: a) HIV b) immunosuppression c) in utero exposure to DES d) history of cancer or cervical intraepithelial neoplasia 2) after 3 or more consecutive normal exams, the Pap smear may be performed less frequently at the discretion of her physician 3) may discontinue at age 65-70 [2] US Preventive Services Task Force 1) Pap smears every 1-3 years beginning with onset of sexual activity, until age 65 2) after age 65, screening is unnecessary if previous smears have been consistently normal American Geriatrics Society 1) screen at 1-3 year intervals until age 70 2) beyond age 70, little evidence for or against screening women who have regularly been screened in previous years 3) older women of any age who have never been screened should be screened until 3 negative Pap smears are obtained 1 year apart (GRS9)* [3] - issue of including HPV DNA screening discussed inadequately 4) continue screening in women > 65 years until 3 negative Pap smears obtained 1 year apart if patient has a new sexual partner since prior Pap smears [4] Medicare covers Pap Smears for women over 65 years of age In 2004 the National Cancer Institute, American Society of Colposcopy & Cervical Pathology & American Cancer Society cosponored a workshop to develop consensus guidelines 1) HPV DNA testing may be added to cervical cytology screening for women > 30 years of age 2) women in whom both cytology & HPV DNA testing are negative need not be screened again for 3 years 3) women with negative cytology but infected with high-risk type of HPV should be rescreened in 6-12 months -> if either repeat test is positive, colposcopy is indicated 4) women who test negative for HPV by DNA testing with cytology showing atypical squamous cells of unknown significance (ASCUS) can be followed with repeat cytology in 12 months 5) women with atypical sqaumous cells - cannot exclude high-grade intraepithelial neoplasia or intraepithelial neoplasia should undergo colposcopy

References

  1. Journal Watch 24(6):52, 2004 Wright TC Jr e al Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening. Obstet Gynecol 103:304, 2004 PMID: 14754700
  2. ACOG PRACTICE BULLETIN CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN-GYNECOLOGISTS NUMBER 109, DECEMBER 2009 http://journals.lww.com/greenjournal/documents/PB109_Cervical_Cytology_Screening.pdf
  3. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. White MC, Shoemaker ML, Benard VB. Cervical Cancer Screening and Incidence by Age: Unmet Needs Near and After the Stopping Age for Screening. Am J Prev Med. 2017 Sep;53(3):392-395 PMID: 28473240 PMCID: PMC5821231 Free PMC article