CLINICAL GUIDELINE
Gynecological Cytology Screening Recommendations
PURPOSE:
The following
consensus guidelines for screening for cervical cancer and management of HPV
positive specimens were developed by faculty at the New York
Presbyterian/Columbia University and
POLICY STATEMENT: This guideline does
not represent a professional care standard governing a provider’s obligations
to patients. Care is revised to meet individual patient needs
AGE
TO START PAP SCREENING: Screening should begin 3 years after the onset of sexual
activity, but not later than age 21.
AGE
TO STOP PAP SCREENING: If a woman has had three negative Pap tests and no abnormal
cytology in the previous 10 years, screening may be discontinued at age 70.
SCREENING
METHODS:
Women
up to age 30 years
A Pap test should be
obtained every two years, unless a woman is HIV-infected or
immunosuppressed for any reason (see below).
Note that even if Pap screening is not indicated at a particular
interval following the onset of testing, other testing may be required,
including screening for Chlamydia or other Sexually Transmitted Diseases.
The
If
the Pap test result is atypical squamous cells of undetermined significance
(ASC-US), the patient may be managed either:
A) Using "reflex HPV testing" with
referral to colposcopy only if they are HPV
positive (i.e. “high-risk” HPV).
-
B) Perform two
repeat cytology tests at 4-6 month intervals with referral to colposcopy if any
of the repeat tests is abnormal.
Gynecological
Cytology Screening Recommendations (cont.)
Women
older than 30 years of age
A) Combining
HPV DNA testing with a Pap test identifies more women with high-grade cervical
cancer precursors than does cytology alone.
Therefore in women older than 30 years of age both a liquid-based Pap
test and a HPV DNA test should be obtained every three years.
Women
who are HPV DNA positive but who have a normal Pap should have both
tests repeated in 6 to 12 months. A
referral to colposcopy should occur if the repeat Pap is LSIL or greater or
if they remain HPV positive.
-
B) A
liquid-based Pap test without HPV testing obtained every two years is also
an acceptable screening approach in women over the age of 30 years who are not
HIV-infected or immunosuppressed for any reason.
HIV
infected and immunosuppressed patients
A
liquid-based Pap test (without HPV testing) should be obtained every
year regardless of age.
Women
who have had a complete hysterectomy (cervix removed)
If the
complete hysterectomy was performed for benign disease and there
is no prior history of high grade CIN documented in the prior ten years and the
patient was adequately screened, further pap screening is not
indicated. In a high risk population, pap screening may be
done at the discretion of the provider.
DOCUMENT
MANAGEMENT:
ACN
KEY
WORDS: Ambulatory, Practice Site
Approved: Daniel Hyman, MD, MMM
Chief Medical Officer, Ambulatory
Care