NEW YORK (Reuters Health) - Cervical cancer screening should begin when a woman turns 21, according to newly revised evidence-based guidelines issued November 20 by the American College of Obstetricians and Gynecologists (ACOG).
ACOG previously recommended that cervical screening begin 3 years after first sexual intercourse or by age 21, whichever occurred first.
"The recommendation to start screening at age 21 years regardless of the age of onset of sexual intercourse is based in part on the very low incidence of cancer in younger women," the guidelines state. "It is also based on the potential for adverse effects associated with follow-up of young women with abnormal cytology screening results."
The updated guidelines also call for women between the ages of 21 and 29 to be screened every 2 years, instead of annually, using the standard Pap test or liquid-based cytology.
Women aged 30 and older who have had three consecutive negative cervical cytology test results and who have no history of cervical intraepithelial neoplasia (CIN) 2 or 3, or cancer, are not HIV infected or immunocompromised, and were not exposed to diethylstilbestrol (DES) in utero may extend the interval between cervical cytology examinations to every 3 years.
Cytology and human papillomavirus (HPV) DNA testing is an appropriate screening strategy for women older than age 30, the guidelines state. Low risk women aged 30 and older who receive negative test results on both cervical cytology screening and HPV DNA testing should wait at least 3 years before being rescreened.
“The tradition of doing a Pap test every year has not been supported by recent scientific evidence," Dr. Alan G. Waxman of the University of New Mexico in Albuquerque, said in an ACOG-issued statement.
"A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful," added Dr. Waxman, who headed development of the updated guidelines, which appear in the December issue of Obstetrics & Gynecology.
In women who have had a total hysterectomy for benign indications and have no prior history of high-grade CIN, routine cytology testing should be discontinued, the guidelines state.
Because cervical cancer develops slowly and risk factors decrease with age, it is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years, the guidelines state.
Women who have been vaccinated against HPV should follow the same screening guidelines as unvaccinated women.
