A direct comparison of the recommendations presented in the above guidelines for screening for cervical cancer in average-risk, asymptomatic women is provided in the tables below. Recommendations for screening in women at increased risk of cervical cancer as well as recommendations for follow-up for abnormal cytology results are beyond the scope of this synthesis.
Areas of Agreement
Initiation and Discontinuation of Screening
ACOG and KPCMI agree that cervical cancer screening should begin at age 21. ACOG recommends that sexually active females younger than age 21 years be counseled and tested for sexually transmitted infections, and be counseled regarding safe sex and contraception—measures which may be carried out without cervical cytology. The guideline developers further agree that screening can be discontinued in older women (between 65 and 70 years [ACOG]; ≥age 65 [KPCMI]) who have had at least three consecutive normal Pap smears and no abnormal test results in the past ten years.
Screening Modality
ACOG and KPCMI agree that both liquid-based and conventional cytology are appropriate methods of screening for asymptomatic, average-risk women. The groups also cite co-testing using the combination of cytology (liquid-based or conventional) plus HPV DNA testing as an appropriate screening test for women older than 30 years.
Screening after Hysterectomy
The guideline developers agree that screening can be discontinued in women who have had a total hysterectomy for benign conditions and have no history of CIN (ACOG specifies high-grade CIN; KPCMI specifies CIN grade 2/3).
Areas of Difference
Screening Interval
KPCMI recommends a screening interval of three years for women undergoing cytology alone, as well as for women age 30 and older undergoing concurrent cytology and HPV testing. ACOG, in contrast, recommends biennial screening for women between the ages of 21 and 29 years, and triennial screening for women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of CIN 2 or CIN 3, are not HIV infected, are not immunocompromised, and were not exposed to diethylstilbestrol in utero. ACOG also recommends that any low-risk woman aged 30 years or older who receives negative test results on both cervical cytology screening and HPV DNA testing should be rescreened no sooner than 3 years subsequently.
Screening after Hysterectomy
Recommendations for women with a history of CIN grade 2/3 who underwent a subsequent hysterectomy differ somewhat. KPCMI recommends three consecutive negative cytology results prior to discontinuation of screening in this population. ACOG recommends continuation of screening even after the period of post-treatment surveillance, adding that while the screening interval may then be extended, there are no good data to support or refute discontinuing screening in this population.
