David Chelmow, M.D., and colleagues from the American College of Obstetricians and Gynecologists, reviewed the best available evidence to update guidelines for cervical cancer screening.

The authors recommend that screening for cervical cancer start at 21 years of age. Women aged 21 to 29 should be screened every three years with cervical cytology alone. Women aged 30 to 65 years should preferentially undergo co-testing with cytology and human papillomavirus (HPV) testing every five years, although screening with cytology alone every three years is acceptable. Routine screening guidelines are not applicable for women with a history of cervical cancer, with HIV infection, who are immunocompromised, or who were exposed to diethylstilbestrol in utero. Routine cytology and HPV testing should be discontinued for women who have had a total hysterectomy and never had cervical intraepithelial neoplasia 2 or higher. Screening by any modality should be discontinued after age 65 for women with adequate prior negative screening. Acceptable screening includes liquid-based and conventional methods of cervical cytology collection. The guidelines are applicable to women regardless of whether they have received the HPV vaccine.

"These recommendation changes are significant for physicians and patients alike," Chelmow said in a statement. "It will take some time and a lot of effort to re-educate everyone that the annual Pap is no longer the standard of care. It is critical, however, that women understand that their annual well-woman visit is still very important for many other aspects of their health care."

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