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Table 1 European and US guidelines on cervical cancer screening and prevention.

From: Guidelines of the Italian Society for Virology on HPV testing and vaccination for cervical cancer prevention

 

European guidelines for quality assurance in cervical cancer screening; 2007 [58]

ACS (American Cancer Society); 2007 [53, 54]

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

     

- 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

  1. NR: not reported.