Guideline-driven
testing

Guidelines continue to strongly recommend co-testing in women ages 30 to 651-5

  1. Allows for timely detection of abnormalities2
  2. Reduces detection of HPV infections that would resolve on their own2
  3. 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
ACOG3,4 Level A:
  1. Pap alone every 3 years
  2. Pap with reflex to HPV upon ASC-US also acceptable
Level A:
  1. Pap alone every 3 years
  2. Preferred: Co-testing with Pap + HPV together every 5 years
Level B:
  1. 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:
  1. Pap alone every 3 years
  2. Co-testing with Pap + HPV together every 5 years
  3. HPV alone every 5 years
HRSA
and
WPSI5
Recommends: Pap alone every 3 years Recommends:
  1. Pap alone every 3 years
  2. 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; 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). Published August 21, 2018. Accessed May 17, 2019. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2018/08/cervical-cancer-screening-update.
  2. US Preventive Services Task Force. Final recommendation statement. Cervical cancer: screening. Updated August 2018. Accessed May 17, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cervical-cancer-screening2.
  3. 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
  4. 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
  5. Health Resources & Services Administration. Women’s preventive services guidelines. Last reviewed September 2018. Accessed June 10, 2019. https://www.hrsa.gov/womens-guidelines/index.html.