Recommendations on cervical cancer screening - Clinical Briefs

Author: Carrie Morantz, Brian Torrey
Date: Dec 15, 2003

The Committee on Practice Bulletins-Gynecology of the American College of Obstetricians and Gynecologists (ACOG) has issued a new, evidence-based practice bulletin on cervical cancer screening. "ACOG Practice Bulletin Number 45: Cervical Cytology Screening," appears in the August 2003 issue of Obstetrics and Gynecology.

According to ACOG, an increasing number of women no longer need annual testing for cervical cancer, and screening can begin later than previously recommended. However, annual pelvic examinations are still advised for women across a broad age range.

ACOG's new recommendations differ slightly from the recently revised recommendations of the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF). Among the new ACOG recommendations are the following:

* The first screening of cervical cytology should occur by approximately three years after first sexual intercourse or by age 21, whichever comes first. (Previously, ACOG called for screening by the onset of sexual activity or by age 18, whichever occurred first.)

* Women younger than 30 years should have cervical cytology screening annually, because these women have a higher likelihood than older women of acquiring high-risk types of human papillomavirus. (Previously, ACOG did not distinguish between age groups.)

* If a woman 30 years or older has negative results on three consecutive annual cervical cytology tests, then she may be rescreened with cervical cytology alone every two to three years.

* No matter what recommended interval for cervical cytology testing a woman follows, data indicate that both liquid-based and conventional methods of cervical cytology are acceptable for use in testing.

* More frequent cervical screening may be required for higher-risk women who have human immunodeficiency virus infection, are immunosuppressed (such as those who have received a kidney transplant), were exposed to diethylstilbestrol in utero, or were previously diagnosed with cervical cancer.

* Women who have undergone hysterectomy with removal of the cervix for benign reasons and with no history of abnormal or cancerous cell growth may discontinue routine cytology testing. Women who have had such a hysterectomy but who have a history of abnormal cell growth (classified as cervical intraepithelial neoplasia [CIN] 2 or 3) should be screened annually until they have three consecutive, negative vaginal cytology tests; then they can discontinue routine screening.

* Physicians can determine on an individual basis when an older woman can stop having cervical cancer screenings, based on such factors as her medical history and the physician's ability to monitor the patient in the future. (The ACS calls for cessation of testing in non-high-risk women at age 70, and the USPSTF by age 65; ACOG notes that because of limited studies of older women, it is difficult to set an across-the-board upper age limit for cervical cancer screening.)

COPYRIGHT 2003 American Academy of Family PhysiciansCOPYRIGHT 2003 Gale Group

 
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