Although cervical cancer is the most common malignant tumor in gynecology, it is easy to be diagnosed and treated early and its prognosis is getting better. Regular women’s health examinations and cervical cancer screening are very important to detect most early cervical cancers and precancerous lesions, to provide early treatment, to improve outcomes and to reduce pain. The revised guidelines of the American College of Obstetricians and Gynecologists for cervical cancer screening are summarized here for friends’ reference. Li Liuxia, Department of Obstetrics and Gynecology, First Affiliated Hospital of Zhengzhou University
ACOG Revised Guidelines for Cervical Cancer Screening
On November 20, the American College of Obstetricians and Gynecologists (ACOG) released Practice Bulletin No. 109 online, which updates the guidelines for cervical cancer screening, recommending that women receive their first cervical cancer screening at age 21, with less frequent screening as appropriate. For a related paper, see Obstet Gynecol 2009, 114(6): 1409]. Recent findings suggest that reducing the frequency of cervical cancer screening does not affect prevention outcomes. Taking into account economic, patient psychological and future reproductive needs, the new ACOG guidelines recommend that cervical cancer screening should be initiated at age 21; screened every 2 years for those aged 21-30 years; screened every 3 years for those aged ≥30 years if 3 consecutive screening results are negative; and for those aged 65-70 years, if 3 consecutive screening results are negative and no abnormal results have been obtained in the last 10 years, screening can be Stop screening. Risk factors for those who need to be screened more frequently include HIV infection, immunocompromise or suppression, history of uterine hexestrol exposure, and history of treatment for grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cervical cancer. Guidelines based on Level A evidence recommend that (i) cervical cancer screening should be performed when women are 21 years of age or older and should be avoided in those younger than 21 years of age because they are at low risk for cervical cancer and premature screening may result in unnecessary or harmful evaluation or treatment. ②For women aged 21-29 years, cervical cytology screening should be performed every 2 years. ③For women ≥30 years of age, the frequency of screening can be changed to every 3 years if they have 3 consecutive negative cervical cytology screening results, no previous history of CIN grade 2 or 3, no HIV infection, no immunocompromise, and no history of hexestrol treatment. ④ Both liquid-based cytology tests and conventional cytology tests can be used. ⑤ Routine screening can be discontinued in women undergoing total hysterectomy for benign disease without a previous history of high-grade CIN. (6) For women ≥30 years of age, combined cytology and HPV DNA testing is recommended, and those with negative results on both tests are considered low-risk, and their subsequent screening interval should not be shorter than 3 years. Guidelines based on Level B evidence recommend that (1) sexually active female adolescents (e.g., <21 years of age) should be screened for STIs and educated about STIs, safe sex practices, and contraception, cervical cytology is not recommended, and endoscopy should not be performed in asymptomatic individuals. ②For women aged 65-70 years, screening may be discontinued if cytology test results are negative for 3 or more consecutive times and there are no abnormal results in the past 10 years. (③For patients treated for a diagnosis of CIN grade 2 or 3 or cancer who have been at risk of disease persistence or recurrence for at least 20 years after completion of treatment or initial surveillance, screening should be offered once a year for at least 20 years. ④ For those who have had their cervix removed during hysterectomy, have CIN grade 2 or 3, or have never achieved a negative result, they must still be screened even if they have completed post-treatment surveillance, but the interval between screenings may be extended. There are no data for or against discontinuation of screening in such patients. Guidelines based on level C evidence recommend (i) that patients should receive gynecologic examinations once a year regardless of the frequency of screening. ② For women who have received anti-HPV-16 and 18 vaccines, the screening regimen is the same as for those who have not received the vaccine.
From the China Medical Tribune