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Screening for Cervical Cancer
Screening is important in detecting early cervical cancer. It is recommended that all women aged 21 to 65 years receive a Pap smear every 3 years if results are normal. Women aged ≥30 years can also elect to do DNA HPV testing in addition to the Pap smear. If they opt to have these two tests done together (i.e., cotesting), they can extend the screening interval to every 5 years if results are normal. As of 2012, screening is not recommend for women <21 years of age regardless of onset of sexual activity.
According to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, if a woman's Pap smear shows abnormal cytology, further evaluation may include but is not limited to colposcopy, endometrial sampling, and/or endocervical sampling. If a Pap smear shows unsatisfactory results (e.g., insufficient sample), a second Pap smear is recommended 2 to 4 months later, regardless of HPV status. For women aged ≥30 years who are HPV-positive and show unsatisfactory cytology, follow-up may consist of either a repeat Pap smear in 2 to 4 months or colposcopy. If the follow-up Pap smear shows further unsatisfactory results, colposcopy is recommended. For women aged ≥30 years who are HPV-positive with a normal Pap smear, repeat cotesting can be done in 1 year. If any repeat HPV test is positive or Pap smear shows significant abnormality, colposcopy is recommended. Depending on the severity of cervical dysplasia, treatment options may range from close monitoring for milder cases to cryotherapy, laser therapy, loop electrosurgical excision procedure (LEEP), or surgery.
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