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Cervical%20cancer%20-%20prevention%20-and-%20screening Diagnosis
Classification
| The 2014 Bethesda System | |
|---|---|
| Interpretation of Epithelial Cell Abnormalities | |
| Squamous cell |
|
| Glandular cell |
|
| Adapted from: Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. Acta Cytol. 2015;59(2):121-132. | |
Evaluation
Contraindications to Use of Human Papilloma Virus (HPV) Vaccine
- Pregnancy
- Moderate or severe acute illness
- Vaccination should be deferred until illness subsides
- Vaccination may be administered to patients with minor acute illnesses based on clinical judgement
- Patients with history of immediate sensitivity reaction to yeast or to any vaccine component should not receive quadrivalent or 9-valent HPV vaccine
- Patients with anaphylactic latex allergy should not receive bivalent HPV vaccine in prefilled syringes
Screening
| Cervical Cancer Screening Recommendations | |||||||
|---|---|---|---|---|---|---|---|
| U.S.1 | Hong Kong College of Obstetricians & Gynaecologists2 | Malaysia Ministry of Health4 | Philippine Cancer Society5 | Cervical Screen Singapore6 | Taiwan Association of Obstetrics & Gynecology8 | Himpunan Onkologi Ginekologi Indonesia9 | |
| Start Pap test screening in female patients | At 21 years of age | 25 years of age or around the 1st vaginal intercourse3 | 20 years of age if sexually active | 21 years of age or within 3 years of onset of sexual activity | 25 years of age in sexually active women; women who have never had sexual intercourse need not undergo screening | 3 years after 1st vaginal intercourse or ≥30 years of age; women who have never had sexual intercourse need not undergo screening | 20 years of age if sexually active |
| Screening interval for women <30 years old | Pap test (conventional and liquid-based): every 3 years | Every 3 years after 2 consecutive normal annual cytology tests.
Annually for women at high risk of developing cervical cancer more rapidly |
Every 3 years after 2 consecutive normal annual tests | Visual inspection of the cervix aided by acetic acid (VIA) once every 3 years in areas without Pap smear capability; Pap smear in all other areas | Every 3 years; may start at an early age and at more frequent intervals if high risk factors7 are present | Annual; If 3 consecutive normal tests, consider test every 3 years | Every 3-5 years either by Pap smear or VIA |
| Screening interval for women ≥30 years old | Cytology screening for women 30-65 years old: Every 3 years Co-testing (cytology/HPV): every 5 years | ||||||
| Human papilloma virus (HPV) DNA test for screening | For women 30-65 years old: Every 5 years along with cytology | HPV testing, either as a co-test or stand-alone test, is not used in women <30 years old | NA | NA | NA | NA | NA |
| When to stop | No screening after adequate screening (3 consecutive negative cytology results or 2 consecutive negative co-tests within past 10 years, with the most recent test within the past 5 years): >65 years old | If all screening tests are normal for the past 10 years and not diagnosed to have high-grade squamous intraepithelial lesion (HSIL): ≥65 years old. Women >65 years old who have never had a Pap test and had been sexually active or who request a test should be screened | 65 years old | 65 years old in women with history of consistently normal screens and not at high risk for cervical cancer | 69 years old if smear taken at 69 years old is negative and 2 previous negative tests within last 10 years. Women >69 years old, with history of sexual activity and who have never undergone Pap smear should be screened | NA | 70 years old in women with history of consistently normal screens |
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