Pap Testing as Primary Screening
Clinical Guidelines on Pap Testing
Several professional organizations have issued recommendations and guidance on the use of pap testing in the era of the HPV vaccine, as well as the use of liquid-based cytology.
ACOG recommendations on the HPV vaccine and pap testing
American College of Obstetrician-Gynecologists (ACOG) recommendations state that "current cervical cytology screening recommendations remain unchanged, and should be followed regardless of HPV vaccination status. Cervical cancer screening should begin approximately 3 years after the onset of vaginal intercourse, or no later than age 21 years. After the first screening, annual cervical cytology screening should be conducted for women younger than 30 years. It is important to note that the currently approved quadrivalent vaccine protects against acquisition of HPV genotypes that account for only 70% of HPV-related cervical cancer and only 90% of genital warts cases, and that therefore the vaccine is a preventive tool and is not a substitute for cancer screening."
ASCCP Consensus Guidelines on cervical cancer testing
The American Society for Colposcopy and Cervical Pathology (ASCCP) has issued consensus guidelines for managing women with cytological abnormalities as detected by the pap test and categorized according to Bethesda 2001 terminology. The 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests and the Management of Women with Cervical Intraepithelial Neoplasia or Adenocarcinoma in situ were published in the October 2007 issue of the American Journal of Obstetrics and Gynecology. Both the cytology and histology guidelines were also reprinted in the October 2007 issue of the Journal of Lower Genital Tract Disease. Algorithms for the guidelines were published solely in the Journal of Lower Genital Tract Disease. Links to all of these documents can be found on the ASCCP website.
ASC position statement on new technologies in cervical cytology screening
The American Society of Cytopathology’s (ASC) position statement on new technologies in cervical cytology screening summarize recent developments and technological advances in pap testing, and state that: "Clinicians and laboratories should utilize cervical cytology screening paradigms that are most appropriate for their patient population and clinical practice. These decisions must be continually re-evaluated as technologies evolve and as independent studies provide scientific data on cost-effective strategies to further reduce morbidity and mortality from cervical cancer."
2001 Bethesda System and terminology
More than 90% of U.S. laboratories use The Bethesda System for reporting pap test results, including its standardized terminology. The Bethesda System is the product of a workshop held in April 2001 in Bethesda, MD, and serves as the basis of guidelines established by the ASCCP.
USPSTF sexually transmitted disease guidelines
The U.S. Preventive Services Task Force (USPSTF) has issued guidelines on screening for several sexually transmitted diseases, including Chlamydia and Gonorrhea. The guidelines recommend screening "for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older non-pregnant women who are at increased risk." The USPSTF also recommends screening "of all sexually active women, including those who are pregnant, for Gonorrhea infection if they are at increased risk for infection."