George F. Sawaya, MD; Shalini Kulasingam, PhD; Thomas D. Denberg, MD, PhD; Amir Qaseem, MD, PhD, MHA; for the Clinical Guidelines Committee of the American College of Physicians *
Note: Best practice advice papers are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP best practice advice papers are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this paper comes exclusively from the ACP operating budget.
Disclosures: Dr. Sawaya reports that he was commissioned by the American College of Physicians to write this manuscript and received an honorarium. Dr. Kulasingam reports personal fees from the American College of Physicians during the conduct of the study. Dr. Barry reports grants, personal fees, and nonfinancial support from the Informed Medical Decisions Foundation/Healthwise and personal fees and nonfinancial support from Massachusetts General Hospital/Harvard Medical School outside the submitted work. Dr. Schünemann reports that he played a critical role in the World Health Organization cervical cancer screening and treatment guidelines for low- and middle-income countries. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?articleid=745942. Disclosures can also be viewed at www.acponline.org/authors/icmje/Conflict OfInterestForms.do?msNum=M14-2426. A record of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: George F. Sawaya, MD, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, Floor 7, Box 0132, San Francisco, CA 94158.
Current Author Addresses: Dr. Sawaya: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, Floor 7, Box 0132, San Francisco, CA 94158.
Dr. Kulasingam: University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, 1300 South 2nd Street, West Bank Office Building, Suite 300, Minneapolis, MN 55454.
Dr. Denberg: Carilion Clinic, PO Box 13727, Roanoke, VA 24036.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Author Contributions:Conception and design: G.F. Sawaya, T. Denberg, A. Qaseem.
Analysis and interpretation of the data: G.F. Sawaya, S. Kulasingam, T. Denberg, A. Qaseem.
Drafting of the article: G.F. Sawaya, S. Kulasingam, T. Denberg, A. Qaseem.
Critical revision of the article for important intellectual content: G.F. Sawaya, S. Kulasingam, T. Denberg, A. Qaseem.
Final approval of the article: G.F. Sawaya, S. Kulasingam, T. Denberg, A. Qaseem.
Obtaining of funding: A. Qaseem.
Administrative, technical, or logistic support: G.F. Sawaya, A. Qaseem.
The purpose of this best practice advice article is to describe the indications for screening for cervical cancer in asymptomatic, average-risk women aged 21 years or older.
The evidence reviewed in this work is a distillation of relevant publications (including systematic reviews) used to support current guidelines.
Clinicians should not screen average-risk women younger than 21 years for cervical cancer.
Clinicians should start screening average-risk women for cervical cancer at age 21 years once every 3 years with cytology (cytologic tests without human papillomavirus [HPV] tests).
Clinicians should not screen average-risk women for cervical cancer with cytology more often than once every 3 years.
Clinicians may use a combination of cytology and HPV testing once every 5 years in average-risk women aged 30 years or older who prefer screening less often than every 3 years.
Clinicians should not perform HPV testing in average-risk women younger than 30 years.
Clinicians should stop screening average-risk women older than 65 years for cervical cancer if they have had 3 consecutive negative cytology results or 2 consecutive negative cytology plus HPV test results within 10 years, with the most recent test performed within 5 years.
Clinicians should not screen average-risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix.
Sawaya GF, Kulasingam S, Denberg TD, et al, for the Clinical Guidelines Committee of the American College of Physicians. Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2015;162:851–859. doi: https://doi.org/10.7326/M14-2426
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Published: Ann Intern Med. 2015;162(12):851-859.
Cancer Screening/Prevention, Guidelines, Hematology/Oncology, High Value Care, Prevention/Screening.
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