Choosing Wisely:

Don’t perform annual cervical cytology (Pap test) or annual HPV screening of immunocompetent women with a history of negative screening.

Rationale and Comments: There is a slight increase in cancer risk by increasing the interval between screens. However, this risk is balanced with potential harm from more colposcopy as a result of spurious HPV infection that, in most women, will clear spontaneously and is unlikely to progress to any clinically relevant cervical disease. Based on modeling studies of three- or five-year intervals, the screening intervals should be greater than a year, but the current evidence does not support a longer screening interval than three years for cervical cytology with HPV triage or for primary HPV screening with cytology triage.
Sponsoring Organizations:
  • American Society for Colposcopy and Cervical Pathology
  • Sources:
  • U.S. Preventive Services Task Force
  • American Cancer Society guidelines
  • Disciplines:
  • Gynecologic
  • Oncologic
  • Preventive Medicine
  • References: • Stout NK, Goldhaber-Fiebert JD, Ortendahl JD, Goldie SJ. Trade-offs in cervical cancer prevention: balancing benefits and risks. Arch Intern Med. 2008; 168:1881–1889.
    • Kulasingam, S.; Havrilesky, L.; Ghebre, R.; Myers, E. Screening for Cervical Cancer: A DecisionAnalysis for the US Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2011. AHRQ Publication No.11-05157-EF.
    • 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.

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