Cervical Cancer Screening Guidelines

Patient Selection and Timing

The American College of Obstetricians and Gynecologists recommends that cervical screening should begin at age 21 years, regardless of sexual activity history, due to the low incidence of cervical cancer in younger women 3
For women aged 21-29 years, screening should be performed every 3 years with Pap tests, as recommended by the American Cancer Society 3
For women aged 30-65 years, the preferred approach is screening every 5 years with both HPV test and Pap test (co-testing), as recommended by the American College of Obstetricians and Gynecologists 3
Women over 65 years with adequate prior normal screening can discontinue screening, according to the US Preventive Services Task Force 3

Ensure proper patient identification and documentation of previous Pap test results, as recommended by the Centers for Disease Control and Prevention 1
Discuss with the patient the purpose and importance of a Pap test, the need for regularly scheduled Pap tests, and whether a Pap test will be obtained during the current visit, as recommended by the American College of Obstetricians and Gynecologists 1
Avoid scheduling during menstruation as blood may interfere with interpretation, according to the Clinical Infectious Diseases journal 2
Patient should avoid vaginal medications, douching, or sexual intercourse for 48 hours before the test, as recommended by the American Cancer Society 2

Use a speculum of appropriate size, adequate lighting, and collection device options, such as conventional or liquid-based cytologic tests, as recommended by the Clinical Infectious Diseases journal 2
Use glass slides and fixative (for conventional method) or liquid transport medium (for liquid-based method), as recommended by the Clinical Infectious Diseases journal 2

Position the patient appropriately (lithotomy position) and insert speculum without lubricant (water can be used if necessary), as recommended by the Clinical Infectious Diseases journal 2
Visualize the cervix completely and ensure that the sample includes cells from the transformation zone, where most cervical neoplasias develop, as recommended by the Centers for Disease Control and Prevention 1
Use spatula to sample ectocervix and cytobrush for endocervical canal, and transfer cells immediately to glass slide and fix promptly, as recommended by the Clinical Infectious Diseases journal 2

Samples should be sent to CLIA-certified laboratories, as recommended by the Centers for Disease Control and Prevention 1
Laboratories should report cytopathology findings according to the Bethesda 2001 terminology, as recommended by the Centers for Disease Control and Prevention 1
Results should be categorized as atypical squamous cells (ASC), low-grade squamous intraepithelial lesions (LSIL), or high-grade intraepithelial lesions (HSIL), as recommended by the Centers for Disease Control and Prevention 1

Document that a Pap test was performed and provide patients with a copy of their Pap test result when available, as recommended by the Centers for Disease Control and Prevention 1
Establish a protocol for following up on abnormal results and ensure appropriate referral pathways for women with abnormal screening results, as recommended by the American College of Obstetricians and Gynecologists 1

Failure to adequately sample the transformation zone, resulting in unsatisfactory specimens, as warned by the Clinical Infectious Diseases journal 2
Over-screening women under 21 years or more frequently than recommended intervals, as warned by the American Cancer Society 4
Inappropriate use of HPV testing in women under 30 years for primary screening, as warned by the Clinical Infectious Diseases journal 2