Secondary Prevention of Cervical Cancer

New in 2022: In maximal resource settings, cervical cancer screening with HPV DNA testing should be offered every 5 years from ages 25 to 65 years (either self- or clinician-collected). On an individual basis, women may elect to receive screening until 70 years of age. ( CB , , H , S )

Women who are ≥65 years of age who have had consistently negative screening results during past ≥15 years may cease screening. Women who are 65 years of age and have a positive result after age 60 should be re-invited to undergo screening 2, 5, and 10 years after the last positive result. If women have received no or irregular screening, they should undergo screening once at 65 years of age, and if the result is negative, exit screening. ( EB , , I , M )

If the results of the HPV DNA test are positive, clinicians should then perform triage with reflex genotyping for HPV 16/18 (with or without HPV 45) and/or cytology as soon as HPV test results are known. ( EB , , H , S )

If triage results are abnormal (i.e., ≥ atypical squamous cells of undetermined significance [ASC-US] or positive for HPV 16/18 [with or without HPV 45]), women should be referred to colposcopy, during which biopsies of any acetowhite (or suggestive of cancer) areas should be taken, even if the acetowhite lesion might appear insignificant. If triage results are negative (e.g., primary HPV positive and cytology triage negative), then repeat HPV testing at the 12-month follow-up. ( EB , , I , S )

If HPV test results are positive at the repeat 12-month follow-up, refer women to colposcopy. If HPV test results are negative at the 12- and 24-month follow-up or negative at any consecutive HPV test 12 months apart, then women should return to routine screening. ( EB , , H , S )

Women who have received HPV and cytology co-testing triage and have HPV-positive results and abnormal cytology should be referred for colposcopy and biopsy. If results are HPV positive and cytology normal, repeat co-testing at 12 months. If at repeat testing HPV is still positive, patients should be referred for colposcopy and biopsy, regardless of cytology results. ( CB , , I , S )

If the results of the biopsy indicate that women have precursor lesions (cervical intraepithelial neoplasia [CIN] 2+), then clinicians should offer loop electrosurgical excision procedure (LEEP); if there is a high level of quality assurance (QA) or, where LEEP is contraindicated, ablative treatments may be offered. ( EB , , H , S )

After women receive treatment for precursor lesions, follow-up should consist of HPV DNA testing at 12 months. If 12-month results are positive, continue annual screening; if not, return to routine screening. ( CB , , I , M )