Guideline-driven
testing

Guidelines continue to strongly recommend co-testing in women ages 30 to 651-6

  • Allows for timely detection of abnormalities2
  • Reduces detection of HPV infections that would resolve on their own2
  • May help prevent unnecessary procedures and stress for the patient2

Evidence-based guidelines from many leading health organizations support the importance of co-testing:

  Ages 21-29 Ages 30-65 Ages > 65
ACOG4,5 Level A:
  • Pap alone every 3 years
  • Pap with reflex to HPV upon ASC-US also acceptable
 Level A:
  • Pap alone every 3 years
  • Preferred: Co-testing with Pap + HPV together every 5 years
Level B Option: HPV Primary every 3 years		 Screening should be discontinued if patient has had adequate negative prior screening results and no history of CIN2+. Recommend continuing age-based screening for ≥20 years in those patients with a history of CIN2, CIN3, or adenocarcinoma in situ. Adequate negative prior screening results is defined as 3 consecutive negative Paps or 2 consecutive negative co-tests within the past 10 years, with the most recent test occurring within the past 5 years.
USPSTF2 Grade A: Pap alone every 3 years Grade A:
  • Pap alone every 3 years
  • Co-testing with Pap + HPV together every 5 years
  • HPV alone every 5 years
ACS,
ASCP,
ASCCP3		 Strong Recommendation: Pap alone every 3 years Strong Recommendation:
  • Pap alone every 3 years
  • Co-testing with Pap + HPV together every 5 years
    • HPV Primary is mentioned every 3 years
HRSA
and
WPSI6		 Recommends: Pap alone every 3 years Recommends:
  • Pap alone every 3 years
  • Co-testing with Pap + HPV together
 No comments

NOTE: This table is a summary for convenience and should not be considered complete. For complete details, please see the respective guidelines.

ACOG = American College of Obstetricians and Gynecology; USPSTF = United States Preventive Services Task Force; ACS = American Cancer Society; ASCP = American Society for Clinical Pathology; ASCCP= American Society for Colposcopy and Cervical Pathology; HRSA = Health Resources & Services Administration; WPSI = Women’s Preventive Services Initiative

References
  1. American College of Obstetricians and Gynecologists. Practice advisory: cervical cancer screening (update). https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Cervical-Cancer-Screening-Update?IsMobileSet=false. Published August 21, 2018. Accessed May 17, 2019.
  2. US Preventive Services Task Force. Final recommendation statement. Cervical cancer: screening. https://www. uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cervical-cancer-screening2. Updated August 2018. Accessed May 17, 2019.
  3. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172. doi: 10.3322/caac.21139
  4. American College of Obstetricians and Gynecologists. Practice bulletin no. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors. 2013;122(6):1338-1367. doi: 10.1097/01.AOG.0000438960.31355.9e
  5. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 168: cervical cancer screening and prevention. Obstet Gynecol. 2016;128(4):e111-e130. doi: 10.1097/AOG.0000000000001708
  6. Health Resources & Services Administration. Women’s preventive services guidelines. https://www.hrsa.gov/womens-guidelines/index.html. Last reviewed September 2018. Accessed June 10, 2019.