Table 1 – STI Treatment Guidelines
Cervical cancer screening and surveillance recommendations
| Population | Screening specifics | Guideline group, yr of recommendation | |||
|---|---|---|---|---|---|
| USPSTF, 2018 | ACOG, 2016 | ACS, 2020 | |||
| Persons at average risk | Age to start screening | 21 yrs | 21 yrs | 25 yrs | |
| Age to end screening | 65 yrs | 65 yrs | 65 yrs | ||
| If three consecutive negative cytology tests or two negative cytology plus HPV tests or two negative HPV tests (ACS) with the most recent within the previous 5 yrs and no abnormal tests within the previous 10 yrs (ACS) and no CIN 2 or CIN 3 within the previous 25 yrs | |||||
| Screening test options and intervals | Aged 21–65 yrs: Cytology alone every 3 yrs or Aged 21–29 yrs: Cytology alone every 3 yrs Aged 30–65 yrs: Cytology plus HPV testing every 5 yrs or Aged 21–29 yrs: Cytology alone every 3 yrs Aged 30–65: HPV testing alone every 5 yrs* |
HPV testing alone every 5 yrs or Cytology plus HPV testing every 5 yrs or Cytology alone every 3 yrs |
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| Preferred strategies | Cytology alone every 3 yrs and HPV testing alone every 5 yrs (equally preferred) | Cytology plus HPV testing every 5 yrs | HPV testing alone every 5 yrs | ||
| Previous hysterectomy with removal of cervix | Screening not recommended after hysterectomy for benign indications Surveillance testing recommended for previous diagnosis of high-grade precancer, AIS, or cancer |
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| Persons with an immunocompromising medical condition† (e.g., HIV infection or solid organ transplantation) | Age to start screening | No specific recommendation | Within 1 yr of onset of sexual activity or, if already sexually active, within the first year after HIV or other immunocompromising medical condition diagnosis but no later than age 21 yrs | ||
| Age to end screening | None; lifelong screening recommended | ||||
| Screening test options and intervals | Aged 21–65 yrs: Cytology every year; after three consecutive annual normal cytology test results, screening can be every 3 yrs or Aged 21–29 yrs: Cytology every year Aged 30–65 yrs: Cytology plus HPV testing every 3 yrs |
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| Previous hysterectomy with removal of cervix | Not specified | ||||
| Persons within utero exposure to diethylstilbestrol§ | Age to start screening | No specific recommendation | Not specified | No specific recommendation | |
| Age to end screening | Not specified | ||||
| Screening test options and intervals | Cytology alone annually | ||||
| Previous hysterectomy with removal of cervix | Not specified | ||||
| Persons who have received HPV vaccination | No changes to the screening approaches above | ||||
| Population | Screening specifics | ASCCP, 2019, and ACOG, 2020 | |||
| Persons with a diagnosis of CIN 2 or CIN 3 (histologic HSIL¶) within the previous 25 yrs | Age to start screening | Not applicable | |||
| Age to end screening | May end at age 65 yrs if CIN diagnosis ≥25 yrs ago and criteria for ending screening met, otherwise continue screening past age 65 yrs Continued screening for ≥25 yrs after diagnosis is acceptable if patient is in good health |
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| Screening test options and intervals | Initial surveillance: HPV testing alone or cytology plus HPV testing at 6, 18, and 30 mos or Cytology at 6, 12, 18, 24, and 30 mos Long-term surveillance: HPV testing alone or cytology plus HPV testing every 3 yrs or Cytology alone annually Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs Routine screening can resume after the posttreatment surveillance period |
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| Previous hysterectomy with removal of cervix | HPV testing alone or cytology plus HPV testing every 3 yrs or Cytology alone annually Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs |
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Source: Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.
Abbreviations: ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; AIS = adenocarcinoma in situ; ASCCP = American Society for Colposcopy and Cervical Pathology; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; USPSTF = U.S. Preventive Services Task Force.
* Considered an alternative screening strategy by ACOG.
† Panel for Opportunistic Infections, ACOG, 2016.
§ ACOG, 2016.
¶ Either by cytology or by histology; includes a persistent cytologic diagnosis of atypical squamous cells, cannot rule out HSIL.
Page last reviewed: July 22, 2021