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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
Population	Screening specifics	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
	Age to end screening	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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