Cervical Cancer : Screening

1.-Annual Paps to begin after first sexual activity and/or after age 18.
2.-Test every 1-2 years until age 30.(Some recommend that after three normal Paps,screening can be every 2-3 years after age of 30 as the squamous metaplasia are - the substrate for neoplasia- is diminished in most women in their 30s).If an older woman's sexual practices change,consider restarting more frequent screening.
3.-Consider discontinuing Pap tests after age 65-70 in well screened women with no history of significant dysplasia.Evidence does not support a specific age to stop screening.Restart screening if sexual practices change to more frequency.
4.-Consider discontinuing Pap testing in women whose uterus and cervix have been removed and who have no history of high-grade cervical dysplasia or cancer.(Consider screening vaginal cuff and walls for vaginal dysplasia every 1 to 2 years.)
5.-Continue annual Pap testing in women with a history of cervical cancer in utero exposure to DES (diethylstilbestrol) or who are immunocompromised.
6.-Screening will continue long after the advent of multivalent HPV vaccines to prevent the 30% of cancers linked to high-risk HPV types that are not in the vaccine,to protect the previously HPV-infected.
7.-HPV 16/18 testing may permit less aggressive management of women with other high-risk HPV infection.A single positive test for HPV 16/18 is twice as likely as an LSIL Pap to identify women at high risk for CIN 3+.Women with ASCUS who are HPV DNA-positive and women with LSIL have the same risk of having high-grade disease and should therefore be managed identically.When citology is negative and HPV positive, repeat both tests in 6-12 months.

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