Joint guidelines from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (ACS/ASCCP/ASCP) define adequate prior screening as 3 consecutive negative cytology results or 2 consecutive negative cotesting results within 10 years before stopping screening, with the most recent test occurring within 5 years. 6 The guidelines further state that routine screening should continue for at least 20 years after spontaneous regression or appropriate management of a precancerous lesion, even if this extends screening past age 65 years. Once screening has stopped, it should not resume in women older than 65 years, even if they report having a new sexual partner.
Women Older Than 65 Years Who Have Not Been Adequately Screened
Recent data suggest that one-fourth of women aged 45 to 64 years have not been screened for cervical cancer in the preceding 3 years. 9 In particular, women with limited access to care, women from racial/ethnic minority groups, and women from countries where screening is not available may be less likely to meet criteria for adequate prior screening. Certain considerations may also support screening in women older than 65 years who are otherwise at high risk (ie, women with a history of high-grade precancerous lesions or cervical cancer, in utero exposure to diethylstilbestrol, or a compromised immune system). 2
Screening Interval
Screening more frequently than every 3 years with cytology alone confers little additional benefit, with a large increase Roxas city sexy women in harms, including additional procedures and assessment and treatment of transient lesions. Treatment of lesions that would otherwise resolve on their own is harmful because it can lead to procedures with unwanted adverse effects, including the potential for cervical incompetence and preterm labor during pregnancy. Evidence from RCTs, observational studies, and modeling studies suggest that a 5-year screening interval for primary hrHPV testing alone or cotesting offers the best balance of benefits and harms. Screening more frequently than every 5 years with primary hrHPV testing alone or cotesting does not substantially improve benefit but significantly increases the number of screening tests and colposcopies.
Treatment
Screening aims to identify high-grade precancerous cervical lesions to prevent progression to cervical cancer. High-grade cervical lesions may be treated with excisional and ablative therapies. Early-stage cervical cancer may be treated with surgery (hysterectomy) or chemotherapy. Treatment of precancerous lesions is less invasive than treatment of cancer. 2
Race/Ethnicity, Geography, and Cervical Cancer
The incidence of and mortality from cervical cancer remain relatively high among certain populations. The overall mortality rate from cervical cancer among African American women is 10.1 deaths per 100,000 women, 10 which is more than twice the rate among white women (when adjusted for hysterectomy rate), although the gap has narrowed over time. Mortality is higher among older African American women. Several studies have found that African American women are screened for cervical cancer at rates similar to those for white women and that inadequate follow-up after screening and differences in treatment may be important contributing factors. The higher mortality rate in African American women may also be attributable, in part, to the higher than average rate of adenocarcinoma, which carries a worse prognosis than the most common type of cervical cancer (squamous cell carcinoma). 10-12
American Indian/Alaska Native women also have higher rates of cervical cancer mortality (3.2 deaths per 100,000 women) than the US average. 10 Factors driving this higher rate erican Indian/Alaska Native women in the 2012 Behavioral Risk Factor Surveillance System reported not receiving a Papanicolaou [Pap] test in the past 5 years) 13 and inadequate follow-up. 2 Hispanic women have a significantly higher incidence rate of cervical cancer and slightly higher mortality rate (2.6 deaths per 100,000 women [unadjusted for hysterectomy rate]), with especially high rates occurring along the Texas-Mexico border. Although white women overall have the lowest mortality rate from cervical cancer, white women living in geographically isolated and medically underserved areas (particularly Appalachia) have much higher mortality rates than the US average. Asian women also have lower screening rates, especially those who have recently immigrated to the United States and may have language or cultural barriers to screening. 10
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