How to perform cervical screening

  Women should be screened for cervical cancer from the age of 21 years old, but women under 21 years old do not need to be screened for cervical cancer unless they have HIV infection and do not need to consider the age of first sexual intercourse or other related risk factors.  2. Women aged 21-29 years should be screened by cervical cytology only, once every 3 years; under 30 years of age, combined screening is not necessary, nor is annual screening.  3. Combined screening with cytology plus HPV testing is recommended every 5 years for women aged 30-65 years; cytology screening every 3 years is also possible. Annual screening is not necessary.  4. For screening, both liquid-based and conventional smear methods are acceptable.  5. For women with a clear negative prior screening result and no history of CIN2 or higher grade lesions, all screening should be discontinued after age 65. A definitive negative prior screening result is defined as three consecutive negative cytology results or two consecutive negative combined screening results within the last 10 years, but the most recent screening should be within 5 years.  6. Routine cytologic screening and HPV testing should be discontinued for women who have undergone total hysterectomy (no cervix) and have no history of CIN2 or higher grade lesions and do not need to restart screening for any reason.  7. Women with the following risk factors may require more frequent cervical cancer screening than the routine screening guidelines established for the general population: (1) HIV-infected women; (2) immunocompromised women (e.g., solid organ transplant recipients); (3) prenatal exposure to ethylene estradiol; (4) prior history of CIN2, CIN3, or cervical cancer; 8. Women with CIN2, CIN3 or in situ adenocarcinoma should be screened continuously for 20 years from spontaneous regression or after appropriate treatment, even if they are over 65 years of age; 9. For women with total hysterectomy who have a history of CIN2 or higher grade lesions, or cervical cancer within the past 20 years, they should be screened continuously. The previously stated protocol of individual cytologic screening every 3 years after treatment for a total of 20 years seems reasonable for this group of women as well.  10. For women 25 years of age and older, FDA-approved HPV test-based screening may also be considered in place of the current cytology-based cervical cancer screening regimen. However, in the current guidelines of most societies, cytologic screening alone, or combined screening remains the preferred recommended regimen. If HPV testing is used for primary screening, the ASCCP and SGO interim guidelines should be followed.  11. For women with an ASC-US cytology result and a negative HPV test, the risk of CIN3 is relatively low whether at combined screening or ASC-US-fed HPV testing, but the risk is slightly higher compared to women with a double-negative result at combined screening, so a combined test in year 3 is recommended.  12. Women aged 30 years and older with negative cytology and positive HPV results from the combined test should follow one of two options: (1) Repeat the combined test after 12 months. Colposcopy should be performed if repeat cytology results are abnormal for ASC-US and above, or if HPV testing remains positive. Otherwise perform a combined screening test in year 3.  (2) HPV genotyping test can be performed immediately to check HPV-16 and HPV-18 infection. Those who are positive for either HPV genotype should undergo colposcopy directly. Those who are negative for both HPV genotypes should undergo combined screening after 12 months and be treated clinically according to the appropriate results and the 2012 ASCCP revised guidelines for the management of abnormal cervical cancer screening results.