Screening for Cervical Cancer

For average-risk women aged 30 to 65 years, the WPSI recommends informed shared decision-making between the patient and her clinician regarding recommended and available screening strategies. 

Women who have received the human papillomavirus vaccine should be screened according to the same guidelines as women who have not received the vaccine. 

These recommendations are for routine screening in average-risk women and do not apply to women infected with human immunodeficiency virus, women who are immunocompromised because of another etiology (such as those who have received solid organ transplantation), women exposed to diethylstilbestrol in utero, or women treated for cervical intraepithelial neoplasia grade 2 or higher within the past 20 years. Screening strategies for high-risk women are outside the scope of these recommendations. 

Cervical cancer screening is not recommended for women younger than 21 years or those older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. Adequate prior negative screening is defined as documentation (or a reliable patient report) of three consecutive negative cytology results or two consecutive negative cotest results within the previous 10 years with the most recent test within the past 5 years. Cervical cancer screening is also not recommended for women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesions (eg, cervical intraepithelial neoplasia grade 2 or grade 3 or cervical cancer within the past 20 years). 

Decisions regarding clinician or patient collected screening should be based on shared decision-making and be consistent with FDA approved methods. The WPSI recommends clinicians provide or refer for appropriate follow up for any abnormal screening result, including self- or clinician-collected samples. Follow-up for abnormal test results should follow established clinical guidelines, however recommendations for management of abnormal test results are beyond the scope of this recommendation. 

Discussion and education related to cervical screening recommendations should be patient centered, particularly for patients with differential access, or who may need support for follow-up. The  WPSI recommendation, Patient Navigation Services for Breast and Cervical Cancer Screening, provides additional guidance on increasing utilization of screening recommendations.

1. Research on patient preferences and experiences with hrHPV test self-collection in clinical and non-clinical settings.
2. Studies comparing rates of follow-up for abnormal results and clinical outcomes for self-collected vs clinician collected cervical hrHPV tests; and effectiveness of patient navigation and other methods supporting follow-up care. 
3. Studies that stratify outcomes based on age at first screening and HPV vaccine status to evaluate the effectiveness of HPV vaccination, and consider vaccine dose, characteristics of partners including vaccination status, and women who have never been sexually active on the incidence of precancer, cervical cancer, and mortality.  
4. Comparative effectiveness studies of patient versus clinician collected hrHPV testing, including interval comparisons, to assess optimal screening intervals for self-collected specimens.