PPRNet Practice Guidelines
Cancer Screening
Practice
guideline: Pap test in women
>=18 years of age without hysterectomies at least every 3 years
The USPSTF strongly recommends screening for cervical cancer in women who
have been sexually active and have a cervix. The USPSTF found good evidence from
multiple observational studies that screening with cervical cytology (Pap
smears) reduces incidence of and mortality from cervical cancer. Direct evidence
to determine the optimal starting and stopping age and interval for screening is
limited. Indirect evidence suggests most of the benefit can be obtained by
beginning screening within 3 years of onset of sexual activity or age 21
(whichever comes first) and screening at least every 3 years. The USPSTF found
no direct evidence that annual screening achieves better outcomes than screening
every 3 years.
Discontinuation of cervical cancer screening in older women is appropriate,
provided women have had adequate recent screening with normal Pap results. The
USPSTF found evidence that yield of screening was low in previously screened
women after age 65. The American Cancer Society (ACS) suggests stopping cervical
cancer screening at age 70.
Discontinuation of cytological screening after total hysterectomy for benign disease (e.g., no evidence of cervical neoplasia or cancer) is appropriate given the low yield of screening and the potential harms from false-positive results in this population.
Additional resource:
USPSTF Recommendations and Rationale
