Choosing Wisely:

Don’t perform cervical cytology (Pap test) or HPV screening in immunocompetent women under age 21.

Rationale and Comments: Cervical cancer is rare in adolescents and screening does not appear to lower that risk. Screening adolescents for cervical cancer exposes them to the potential harms of tests, biopsies, and procedures, without proven benefit.
Sponsoring Organizations:
  • American Society for Colposcopy and Cervical Pathology
  • Sources:
  • American Cancer Society guidelines
  • Disciplines:
  • Oncologic
  • Preventive Medicine
  • Gynecologic
  • References: • American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology.
    Am J Clin Pathol. 2012 Apr;137(4):516-42.
    CA Cancer J Clin. 2012 May-Jun;62(3):147-72.
    J Low Genit Tract Dis. 2012 Jul;16(3):175-204.
    http://seer.cancer.gov/statfacts/html/cervix.html
    • Lee JW, Berkowitz Z, Saraiya M. Low-risk human papillomavirus testing and other nonrecommended human papillomavirus testing practices among U.S. health care providers. Obstet Gynecol. 2011 Jul;118(1):4-13.
    • American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology.
    Am J Clin Pathol. 2012 Apr;137(4):516-42.
    CA Cancer J Clin. 2012 May-Jun;62(3):147-72.
    J Low Genit Tract Dis. 2012 Jul;16(3):175-204.
    • Booth CN, Bashleben C, Filomena CA, Means MM, Wasserman PG, Souers RJ, Henry MR. Monitoring and ordering practices for human papillomavirus in cervical cytology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 5. Arch Pathol Lab Med. 2013 Feb;137(2):214-9.
    • College of American Pathologists Policy on HPV testing: http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/hpv-testing.pdf

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