Cervical Cancer Screening Recommendations

1.  Cervical Cancer Screening Recommendations
Bethesda classification

2. For a women less than 25 years of age, a Pap result of “atypical squamous
cells of undetermined significance,” is preferably followed by another pap
smear in 1 year

3. In women over 30 years of age, the preferred routine screening regimen is co-
testing (cytology + HPV testing) every 5 years
in a woman with negative HPV, the risk of significant cytologic abnormality is
low and should be followed by routine screening (cotesting in 5 years).
women aged 21 to 24 years of age with ASC-US or LSIL should have repeat
cytology in 1 year. If that repeat cytology is negative, ASC-US or LSIL, the
clinician should repeat cytology in another 12 months. If the repeat cytology
shows high-grade atypical squamous cells (ASC-H), atypical glandular cells
(AGC), or high-grade squamous intraepithelial lesions (HSIL), the clinician
should proceed to colposcopy at that time. Once there are two consecutive
negative cytologies, normal screening can be resumed. If the repeat cytology
(on the third Pap) is ASC-US or greater, it is recommended to proceed to
colposcopy.

4. According to the current ASCCP guidelines, any result of ASC-H should be
followed by colposcopy. This should happen regardless of HPV result in a
woman more than 25 years of age due to the possibility of significant cytologic
abnormality.
Types 16 and 18 are particularly correlated with cervical cancer and should
prompt more frequent monitoring. Women more than 30 years of age with
normal cytology and the presence of high-risk sub-types of HPV should have
repeat cotesting (cytology and HPV testing) at 1 year. If the high-risk sub-type

5. is still present at that time or the cytology is ASC-US or greater, clinicians
should proceed with colposcopy.
All subcategories of AGC should proceed with colposcopy with endocervical
sampling and endometrial sampling in women who are 35 years of age or
older, OR at risk for endometrial neoplasia
Although HPV status is useful in the management of abnormal cervical
pathology, it is not predictive of endometrial cancer and AGC should prompt
endometrial biopsy even in the absence of HPV infection

6. The preferred action in this step is to proceed to colposcopy without
endocervical sampling during this pregnancy. Deferring until 6 weeks
postpartum is an option, but not the preferred recommendation, due to the risk
of significant cytologic abnormality.
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7. :SUMMERY
1-Age 21-24 with ASC-US or LSIL Repeat cytology in 1 year if the result :
Negative , ASC-US or LSIL Repeat cytology in 1 year-
AGC, HSIL, ASC-H colposcopy
2-Age >30 with TZ absent or insufficient + HPV negative  routine
testing every 5 years-screening regimen is co
testing every 1-coPositive+ HPVTZ absent or insufficientAge >30 with-3
years
-corepeatPositivecytology and + HPVnormalwith30 yearsAge >-4
.testing at 1 year
regardless of HPVcolposcopyshould be followed byH-ASCny result ofA-5
result.
colposcopyPositiveHPV+LSIL-6
- LSIL + No HPV Test  colposcopy
if theyearat 1testing-repeat conegativeHPV+LSIL30 yearsAge >-
yearat 3testing-repeat coresult negative
7- Age >35 years with AGC  with colposcopy with endocervical sampling.
8-Women with HSIL  colposcopy with endocervical assessment
Prepared by dr.anas alsaab