In 1995, the American College of Obstetricians and Gynecologists (ACOG) recommended a new cervical cancer screening protocol that begins with Pap smear cytology and pelvic examination after sexual debut or at age 18 years, with one-year intervals between screenings. Although not well supported by evidence, the protocol is easy to remember because it is consistent with adulthood in the legal sense and easy for physicians and patients to remember. The Pap smear method is easy to operate in conjunction with annual physical examinations, such as contraceptive counseling, breast cancer screening, monitoring of blood pressure, and other routine physical examinations, and patient compliance is relatively good, making it easy for physicians to include it as part of their routine examinations. Although the Pap smear method has the drawbacks of higher specificity and lower sensitivity, however, abnormal cytologic leakage can be compensated for by annual examinations. Since then, the program has been implemented. In 2002 and 2003, the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force all introduced their own screening programs. In 2006, the American Society for Colposcopy and Cervical Pathology also introduced screening protocols, most of which are complex and not easy to remember, although they are all different from each other. Pap smears combined with HPV-DNA testing were approved for use by the US Food and Drug Administration, adding value but lacking clinical evidence. Because of its limited clinical value and high cost, many guidelines state that Pap smears and HPV-DNA surveillance should not be performed more than once every three years, yet more patients, physicians, and laboratories are performing them annually. Between 2009 and 2011, the American Society for Clinical Pathology reconvened an expert panel and evaluated the evidence to introduce a new protocol. There are a number of different perspectives and controversies here. Many perspectives used some of the evidence to implement high-quality cervical cancer prevention programs, but of course there were also concerns about cost. Cervical cancer is rare until the age of 20, and the incidence of cervical cancer does not increase significantly until the age of 25 or 30. Patients with cancer detected by screening tend to have early lesions and therefore the vast majority are curable. For the vast majority of patients, subextensive, fertility-preserving surgery is curative, with relatively low incidence and mortality rates for patients with early-stage cancer. In 2009, the ACOG considered first screening to be no later than 21 years of age, and the panel agreed that incidence was low before 21 years of age, and that the population they defined as high risk was somewhat different. the ACOG defined average risk as immunocompromised women. Early cervical lesions in young women can be fought by the normal immune system, thus avoiding overdiagnosis. The consequent complications of the procedure are thus also reduced. Because there are no large prospective randomized controlled studies of immunocompromised patients, the U.S. Prevention Task Force, cautiously stating its view that there is no adequate basis for starting screening before age 21 in the immunosuppressed population, nevertheless proposed an age of cervical cancer screening within 3 years of first sexual intercourse, with first screening no later than age 21. Studies have shown that the interval between Pap smears can be extended to three years for women after 30 years of age who have had good prior cytology. The incidence of cervical cancer may increase if cervical cancer screening occurs every five years, if one abnormal Pap cytology result is not addressed, and if steps are not taken to prevent cervical lesions from turning into cervical cancer. For women between the ages of 20 and 30, the optimal interval needs to be studied, and given the lower sensitivity of Pap smears, the minimum standard for extended screening intervals is two consecutive normal cytology results. Understanding the new cervical screening protocol for cervical cancer All evidence suggests that HPV testing is not meaningful in adolescents and that HPV surveillance may be considered for reference in women between 21 and 30 years of age with atypical Pap smear findings. The guidelines also recommend that the same criteria be applied for HPV surveillance in women 30 years of age and older. The U.S. Prevention Task Force, American College of Obstetricians and Gynecologists, ASCCP-ACS-ASCP, is more divided on whether to use HPV-DNA surveillance in women 30 years of age and older, and the U.S. Prevention Task Force believes that Pap cytology screening protocols are safe and cost-effective for women 30 years of age and older, relative to HPV. There are no data to support an interval regimen for HPV screening. It is reasonable to use a three-year interval for Pap smears in this age group, unless the physician wants to extend the interval for a specific group in order to maintain its safety. For example, in patients with previous abnormal Pap cytology, impaired immune function, or poor compliance with three-year screening, HPV surveillance may be considered in these cases, or Pap cytology surveillance may be shortened. For low-risk women with no prior cancer or precancerous lesions who are on a formal screening regimen, the benefit of additional screening is less, and the USPSTF, ASCCP, and ACS recommend 65 years as the age of termination of screening. If a clinician does not have a history of three previous normal Pap smears in the previous 10 years, then a new implementation Pap smear should be done. If a patient has vaginal bleeding, vulvar discomfort, or other gynecologic or urologic symptoms, then a complete gynecologic examination with appropriate diagnostic testing should be performed. In addition, the likelihood of vaginal cancer after hysterectomy is low, and all guidelines suggest that vaginal Pap smears may be considered suspended in the absence of a history of cancer and high intraepithelial neoplasia. The risk of cervical cancer is 2-3 times higher in patients with high cervical intraepithelial neoplasia, but mortality from cervical cancer is lower because many cancer patients are diagnosed early and we have no prospective evidence that increasing the frequency of screening improves the detection rate in patients with early-stage cancer. Considering that the morbidity and mortality rates are already relatively low with today’s protocols, all screening protocols recommend at least 20 years of follow-up for patients with high cervical intraepithelial neoplasia. Incidence of cervical cancer and mortality can be reduced by increasing the frequency of screening in previously unscreened populations. An appropriate cancer screening program is necessary given the differences between cultures, languages, and education faced by patients. A good guideline should facilitate the management of patients with abnormal results and have good compliance.