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July 2014

Choosing a Screening Method for Cervical CancerPapanicolaou Testing Alone or With Human Papillomavirus Testing

Author Affiliations
  • 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
JAMA Intern Med. 2014;174(7):1027-1028. doi:10.1001/jamainternmed.2014.1368

Screening for cervical cancer with the Papanicolaou (Pap) test has been remarkably successful at reducing the morbidity and mortality rates associated with this disease. The discovery that human papillomavirus (HPV) has an essential role in cervical carcinogenesis led to the development of molecular tests to measure the presence of HPV types associated with cancer. In 2012, screening guidelines were updated to incorporate HPV testing.1,2 According to these guidelines, women 21 to 29 years old should undergo screening with a Pap test every 3 years; HPV testing is not recommended owing to the high prevalence of HPV infection in this age group. Women older than 65 years who have had adequate prior screening and are at low risk for cervical cancer should no longer undergo screening. There are 2 options for screening in women 30 to 65 years old. The US Preventive Services Task Force (USPSTF) recommends that women in this age group undergo screening with a Pap test every 3 years or Pap-plus-HPV testing (cotesting) every 5 years.1 The American Cancer Society, the American Society of Colposcopy and Cervical Pathology, and the American Society of Clinical Pathology (ACS/ASCCP/ASCP) recommend the same options, except they classify Pap-plus-HPV testing every 5 years as “preferred” and screening with Pap testing alone every 3 years as “acceptable.”2

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