Update on prevention and screening of cervical cancer

Table 1 Cervical cancer risk factors

Cervical cancer risk factors[17-19]
Genital Infection with high risk human papillomavirus
HIV infection
Smoking
Younger age at first sexual intercourse
Greater number of sexual partners
Oral contraceptives use greater than 5 yr
Having 4 or greater full-term pregnancies
History of sexual transmitted diseases

HIV: Human immunodeficiency virus.

Table 2 Recommendations for human papillomavirus vaccination by the Advisory Committee on Immunization Practices

Population	Recommendation for HPV vaccination
Females 11-12 yr of age	Routine vaccination with 3 doses at 0, 1-2, and 6 mo of either HPV2 or HPV4. Can be initiated as early as age 9 and be given up to age 26
Females 13-26 yr of age	Catch up immunization with 3 doses at 0, 1-2, and 6 mo of either HPV2 or HPV4
Males age 11-12 yr	Routine vaccination with HPV4 with 3 doses at 0, 1-2, and 6 mo. Can be initiated as young as age 9 and be given up to age 26
Female or males with inadequate dose of HPV vaccine	Minimum time between 1st and 2nd vaccine doses is 1 mo. Minimum time between the 2nd and 3rd vaccine doses is 3 mo. Insufficient receipt of HPV vaccine due to shorter than the recommended dosing interval should be re-administered
Females or males with interrupted vaccine schedule	HPV vaccination does not need to be restarted. The 2nd dose should be administered as quick as possible if delayed after the 1st dose. The 2nd and 3rd dose should be separated by 3 mo. If just the 3rd dose is late, it should be given as soon as possible

HPV: Human papillomavirus vaccine; HPV2: Bivalent human papillomavirus vaccine (Cervarix); HPV4: Quadrivalent human papillomavirus vaccine (Gardasil).

Table 3 Comparison of cervical cancer screening guidelines

Population	Current GuidelinesACS/ACOG/USPSTF 2012	Prior ACS guideline 2002/2003	Prior ACOG guideline 2009	Prior USPSTF guideline 2003
Females younger than 21 yr of age	Begin screening at age 21	Begin 3 yr following the onset of vaginal intercourse, but no later than 21 yr	Begin 3 yr following the onset of vaginal intercourse, but no later than 21 yr	Begin within 3 yr of onset of sexual activity or age 21, whichever is earliest
Females age 21–29 yr	Conventional Pap or liquid based cytology alone every 3 yr	Conventional Pap: Annually; every 2-3 yr for females ≥ 30 with 3 negative cytology tests Liquid-based cytology: Every 2 yr; every 2-3 yr for females ≥ 30 yr with 3 negative cytology tests If HPV testing used: Every 3 yr if HPV negative and cytology negative	Cytology every 2 yr	Conventional Pap: At least every 3 yr Liquid-based cytology: Insufficient evidence If HPV testing used: Insufficient evidence
Females age 30–65 yr	HPV and Pap smear co-testing every 5 yr or Pap smear alone every 3 yr. Do not use HPV testing alone.		HPV and cytology co-testing every 3 yr
Women older than 65	Stop screening if adequate prior negative screening result and women not at high risk	Stop screening in Women ≥ 70 yr with 3 or more recent, consecutive negative tests and no abnormal tests in previous 10 yr	Stop between 65 and 70 yr of age after > 3 consecutive negative cytology tests over the past 10 yr	No screening if adequate prior negative screening result and women not at high risk
Women after hysterectomy	No screening if removal of cervix and no prior high grade pre-cancer or cervical cancer	Discontinue if hysterectomy for benign reasons and no previous high-grade CIN	Stop screening	Discontinue if hysterectomy done for benign reasons
Women who were immunized with HPV	Same as non-immunized women	No vaccines recommended for use at this time period	Same as non- immunized women	No vaccines recommended for use at this time period

ACS: American Cancer Society; ACOG: American Congress of Obstetricians and Gyenocologists; USPSTF: United States Preventive Services Task Force; HPV: Human papillomavirus; CIN: cervical intraepithelial neoplasia.