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screening for cervical cancer

Management: Recommendations: 1) recommendations for average risk women regardless of sexual history or HPV vaccination status [25] a) begin screening for average risk age women at 25 years (ACS) [1,33] - screening women age 21-65 every 3 years (USPSTF) [1] b) women younger than 21 years should not be screened regardless of sexual history [7,9,16,23,25] c) stand-alone HPV testing every 5 years through ages 25-65 years (ACS) [33] d) high risk HPV testing to begin at age 30 years (USPSTF) [1] e) cervical cytology alone every 3 years if HPV testing not available [33] f) women > 65 years of age should not be screened if sufficient previous screening g) women without cervix after hysterectomy should not be screened (see below) [25] 2) other screening recommendations a) in a resource-limited setting, women 30-49 years of age can be screened every 10 years with HPV DNA [21] b) for women who have completed HPV vaccination - screening still recommended [1] - apparently sceening same with or without HPV vaccination [1] - screening every 5 years beginning at age 25-30 years with either cytology or HPV DNA testing (bivalent or quadrivalent vaccine) [22] - screening every 10 years beginning at age 30-35 years with HPV DNA testing [22] - HPV DNA testing associated with significantly increased detection of high-grade precancerous cervical lesions compared to cytology [25] e) women with risk factors may require more frequent screenings: 1] HIV 2] immunosuppression 3] in utero exposure to DES 4] history of cancer or cervical intraepithelial neoplasia f) if cervical cytology is unsatisfactory, repeat Pap smear g) may discontinue screening at age 65-70 [5] - discontinue screening at age 65 provided sufficient negative screening results - 3 consecutive negative Pap smears or 2 consecutive negative Pap smears + negative HPV DNA testing [1] - most recent negative screening test must be within 5 years - no history of cervical intraepithelial neoplasia grade 2 or higher [9,17] h) older women of any age who have never been screened should be screened until 3 negative Pap smears are obtained 1 year apart (GRS9) [18]* - issue of including HPV DNA screening discussed inadequately i) do not screen women after hysterectomy with removal of the cervix for benign disease [16] unless history of cervical intraepithelial neoplasia grade 2 or higher, [17] regardless of history of ovarian cancer or endometrial cancer [1] 3) bimanual examination not recommended as part of screening [15] 4) HPV DNA testing for papillomavirus (cervical specimens) - outperforms cytology for reducing risk of invasive cervical carcinoma [11] - negative HPV DNA more predictive than negative cytology for absence of cervical cancer [27] - because of poor specificity, HPV DNA testing with cytology is not recommended [1] - urine specimen potentially an alternative [12] - HPV testing should not be performed before age 30 [16] 5) self-collected cervicovaginal samples for HPV testing & STD testing [31] 6) screening for chlamydia (Chlamydia DNA) & gonorrhea (Neisseria gonorrhoeae DNA) from urine or self-collected vaginal swabs [15] Also see recommendations for performing Pap smears Notes: - 88% of women comply with USPSTF recommendations for screening, yet 47% of cervical cancers present at late stage [6] - 11% of US women not screened in past 5 years (2012) [13] - prognoses for women with cervical cancer may be better if detected by screening rather than upon workup of symptoms [8] - 19 algorithms too complicated to memorize [10] - HPV vaccination status does not alter recommendations for cervical cancer screening [1] - cervical cancer screening in average-risk women is still initiated too soon & continued for too long [24] - women never screened with 1 in 45 risk of developing cervical cancer in their lifetime [30] - adherence to cytology screening until age 55 lowers risk to 1 in 138; screening until age 70, lower risk to 1 in 160. - screening up to age 55 with negative cytology with 1 in 440 risk of developing cancer; risk is 1 in 1940 with a negative HPV test, & 1 in 2253 with negative HPV-cytology cotesting [30]

Related

cervical cancer Papanicolaou (Pap) smear

General

screening for cancer

References

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