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Table 1 – STI Treatment Guidelines

Cervical cancer screening and surveillance recommendations

Table 1
Population Screening specifics Guideline group, yr of recommendation
USPSTF, 2018 ACOG, 2016 ACS, 2020
Persons at average risk Age to start screening 21 yrs 21 yrs 25 yrs
Age to end screening 65 yrs 65 yrs 65 yrs
If three consecutive negative cytology tests or two negative cytology plus HPV tests or two negative HPV tests (ACS) with the most recent within the previous 5 yrs and no abnormal tests within the previous 10 yrs (ACS) and no CIN 2 or CIN 3 within the previous 25 yrs
Screening test options and intervals Aged 21–65 yrs: Cytology alone every 3 yrs
or
Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65 yrs: Cytology plus HPV testing every 5 yrs
or
Aged 21–29 yrs: Cytology alone every 3 yrs
Aged 30–65: HPV testing alone every 5 yrs*
HPV testing alone every 5 yrs
or
Cytology plus HPV testing every 5 yrs
or
Cytology alone every 3 yrs
Preferred strategies Cytology alone every 3 yrs and HPV testing alone every 5 yrs (equally preferred) Cytology plus HPV testing every 5 yrs HPV testing alone every 5 yrs
Previous hysterectomy with removal of cervix Screening not recommended after hysterectomy for benign indications
Surveillance testing recommended for previous diagnosis of high-grade precancer, AIS, or cancer
Persons with an immunocompromising medical condition† (e.g., HIV infection or solid organ transplantation) Age to start screening No specific recommendation Within 1 yr of onset of sexual activity or, if already sexually active, within the first year after HIV or other immunocompromising medical condition diagnosis but no later than age 21 yrs
Age to end screening None; lifelong screening recommended
Screening test options and intervals Aged 21–65 yrs: Cytology every year; after three consecutive annual normal cytology test results, screening can be every 3 yrs
or
Aged 21–29 yrs: Cytology every year
Aged 30–65 yrs: Cytology plus HPV testing every 3 yrs
Previous hysterectomy with removal of cervix Not specified
Persons within utero exposure to diethylstilbestrol§ Age to start screening No specific recommendation Not specified No specific recommendation
Age to end screening Not specified
Screening test options and intervals Cytology alone annually
Previous hysterectomy with removal of cervix Not specified
Persons who have received HPV vaccination No changes to the screening approaches above
Population Screening specifics ASCCP, 2019, and ACOG, 2020
Persons with a diagnosis of CIN 2 or CIN 3 (histologic HSIL¶) within the previous 25 yrs Age to start screening Not applicable
Age to end screening May end at age 65 yrs if CIN diagnosis ≥25 yrs ago and criteria for ending screening met, otherwise continue screening past age 65 yrs
Continued screening for ≥25 yrs after diagnosis is acceptable if patient is in good health
Screening test options and intervals Initial surveillance:
HPV testing alone or cytology plus HPV testing at 6, 18, and 30 mos
or
Cytology at 6, 12, 18, 24, and 30 mos
Long-term surveillance:
HPV testing alone or cytology plus HPV testing every 3 yrs
or
Cytology alone annually
Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs
Routine screening can resume after the posttreatment surveillance period
Previous hysterectomy with removal of cervix HPV testing alone or cytology plus HPV testing every 3 yrs
or
Cytology alone annually
Continue for ≥25 yrs from the initial CIN diagnosis, even if extends past age 65 yrs

Source: Perkins R, Guido R, Saraiya M, et al. Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016–2020. J Womens Health (Larchmt) 2021;30:5–13.

Abbreviations: ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; AIS = adenocarcinoma in situ; ASCCP = American Society for Colposcopy and Cervical Pathology; CIN = cervical intraepithelial neoplasia; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; USPSTF = U.S. Preventive Services Task Force.

* Considered an alternative screening strategy by ACOG.

Panel for Opportunistic Infections, ACOG, 2016.

§ ACOG, 2016.

Either by cytology or by histology; includes a persistent cytologic diagnosis of atypical squamous cells, cannot rule out HSIL.

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