| European guidelines for quality assurance in cervical cancer screening; 2007 [58] | ACOG (American College of Obstetricians & Gynecologists); 2003 http://www.acog.org | ASCCP (American Society for Colposcopy & Cervical Pathology); 2006 [55, 56] | US Preventive Service Task Force; 2003 http://www.preventiveservices.ahrq.gov | |
---|---|---|---|---|---|
Initiation of screening with Pap cytology | 20–30 yr | about 3 yr after the onset of sexual activity but no later than age 21 yr | about 3 yr after the onset of sexual activity but no later than age 21 yr | NR | within 3 yr of onset of sexual activity or age 21 yr, whichever comes first |
Use of HPV testing in screening programs | Not recommended while waiting for the results of randomized controlled trials. | With cytology in women ≥ 30 yr |  | With cytology in women ≥ 30 yr | Insufficient evidence |
Screening intervals | Â | Â | Â | Â | Â |
- conventional Pap test | 3–5 yr | Annually; every 2–3 yr for women aged ≥ 30 yr with 3 consecutive negative cytology tests. | Annually; every 2–3 yr for women aged ≥ 30 yr with 3 consecutive negative cytology tests. | NR | At least every 3 yr |
- if HPV testing used | NR | Every 3 yr if HPV negative and cytology negative. | Every 3 yr if HPV negative and cytology negative. | NR | Insufficient evidence |
Discontinuation of screening | 60–65 yr with ≥ 3 recent consecutive negative tests. | Women aged ≥ 70 yr with ≥ 3 recent consecutive negative tests and no abnormal tests in prior 10 yr. | Inconclusive evidence to establish upper age limit. | NR | Women aged ≥ 65 yr with negative tests, who are not otherwise at high risk for cervical cancer. |
Management of abnormal cervical cancer screening test - ASC-US - ASC-H - LSIL - HSIL | ASC-US: reflex HPV testing; LSIL: repeat cytology or colposcopy; ASC-H: colposcopy; HSIL: colposcopy and biopsy. | NR | NR | ASC-US: HPV testing, or repeat cytology, or colposcopy in women ≥ 20 yr; ASC-H: colposcopy LSIL: colposcopy HSIL: immediate loop electrosurgical excision or colposcopy with endocervical assessment. | NR |