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Paper Chase #2 | Screening for cervical cancer: USPSTF recommendation statement

Matthew DeLaney, MD, FACEP, FAAEM and Matthieu DeClerck, MD
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BOTTOM LINE: Among other recommendations, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years.

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Margot M. -

Currently where I work, we have been doing paps with reflex HPV testing for those 25-30, does this recommendation mean that we should not do that? or does it mean just not automatic co-testing for those <30, but reflex testing after 25 is still a good idea?

Neda F., MD -

Hi Margot. Based on the article itself, it's the latter option you describe - the not-automatic-co-testing. Happy new year!

Loann T. -

Regarding those who are 65yo+, what is considered adequate testing to stop?
Also, for those with partial hysterectomies - recommendation is to still continue with PAP testing correct?

Neda F., MD -

Hi Loann. According to the guidelines, "The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer." This is a Grade D recommendation.

As for total hysterectomy, "The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer." This is also grade D.

Re: partial hysterectomy, all the evidence we can find says to continue cervical cancer screening in women with partial hysterectomies. Hope this helps! -- Neda

Dr. Brett -

Loann, in my residency training we were always taught that if there is a cervix, there is a chance they could develop cervical cancer. In regards to a partial hysterectomy, if they still have the cervix then our facility and training was such that they were treated according to the guidelines noted above.

Dr. Brett -

A nod to the OG paper chasers: Drs. Andrew Buelt and Joe Weatherly had an EXCELLENT super duper deep dive on HPV screening that was ahead of the times in August 2017. These USPSTF guidelines do seem to align with their pearls from the article: HPV testing alone (albeit hrHPV testing alone) every 5 years seems to be sufficient screening in those women aged 30-65. Way to go, Andrew and Joe! That's it, there ya go.

Neda F., MD -

Thanks, Brett. Yes, that HPV screening piece was a great one!

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Clots and OCP's Full episode audio for MD edition 177:43 min - 83 MB - M4APrimary Care RAP December 2018 Written Summary 520 KB - PDF

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