Annals of Internal Medicine

SUMMARIES FOR PATIENTS

Cervical Cancer Screening in Average-Risk Women The full report is titled “Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.” It is in the 16 June 2015 issue of Annals of Internal Medicine (volume 162, pages 851-859). The authors are G.F. Sawaya, S. Kulasingam, T.D. Denberg, and A. Qaseem, for the Clinical Guidelines Committee of the American College of Physicians. This article was published online first at www.annals .org on 30 April 2015.

What is cervical cancer screening? “Screening” means looking for a disease in people who do not have any signs or symptoms of that disease. Cervical cancer screening can be done with a Papanicolaou (Pap) test and/or a test for human papillomavirus (HPV). The Pap test looks for conditions or tumors that may lead to cervical cancer. The HPV test looks for infections that can lead to precancerous lesions that can eventually become cancer. During these tests, a sample is taken from the cervix, tested, and looked at under a microscope. These tests can sometimes be uncomfortable but are usually not painful. What are the benefits and harms of cervical cancer screening? Cervical cancer screening can be beneficial for women. Screening can lead to early detection and treatment, which reduces illnesses and deaths from cervical cancer. However, screening tests may also cause harms. These harms can include worry about results, pain, and costs. If screening tests show abnormal results, follow-up testing may be needed. Follow-up testing may cause additional harms, sometimes without reducing deaths or illnesses. Who developed these guidelines? The American College of Physicians (ACP) developed advice on cervical cancer screening in average-risk women aged 21 years or older without symptoms. Members of the ACP are internists, physicians who specialize in the care of adults. How did the ACP develop these recommendations? The authors looked at research and clinical guidelines on cervical cancer screening. Using this information, they developed advice for patients and physicians. What does the ACP recommend that patients and doctors do? The ACP offers advice for when women should be screened for cervical cancer and which screening tests should be used. This advice is for women with average risk (those without a family history of cervical cancer, previous abnormal test results, or other risk factors) and no symptoms. Y Clinicians should not screen women younger than 21 years of age for cervical cancer.

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Y Clinicians should start screening average-risk women for cervical cancer at age 21 years. Screening should be done once every 3 years with a Pap test without an HPV test. Y Clinicians should not screen average-risk women for cervical cancer more often than once every 3 years. Y Clinicians can screen women aged 30 years or older with both the Pap and HPV test once every 5 years. This option is for women who want to be screened less often than every 3 years. Y Clinicians should not screen women younger than 30 years with the HPV test. Y Clinicians should stop screening women older than 65 years if they have had 3 consecutive negative results on Pap tests or 2 consecutive negative results on Pap plus HPV tests. Y Clinicians should not screen women of any age who have had a hysterectomy with removal of the cervix.

Ann Intern Med. 2015;162:I-28. doi:10.7326/P15-9019

I-28 © 2015 American College of Physicians

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Summaries for Patients. Cervical Cancer Screening in Average-Risk Women.

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