pap smear guidelines 2021 pdf

21-29. All Rights Reserved. Also, in young women, most HPV infections go away on their own. 2021 Age 21 Age 21-29 . There are now three recommended options for cervical cancer screening in individuals aged 3065 years: primary hrHPV testing every 5 years, cervical cytology alone every 3 years, or co-testing with a combination of cytology and hrHPV testing every 5 years Table 1. 0000009232 00000 n by Carmen Phillips, December 2, 2022, A Pap test, also known as a Papanicolaou test or pap smear, is a test used to determine if there are abnormal cells in the cervix. Available at: Yeh PT, Kennedy CE, de Vuyst H, Narasimhan M. Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Access the screening guidelines for the prevention and early detection of cervical cancer. 0000010470 00000 n The algorithm contains tabs with videos and links to additional resources designed to make it easier to guide your next visit. Ask you to lie on your back on an examination table. Reducing Cancers Global Burden: A Conversation with NCIs Dr. Satish Gopal, If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. Data from Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. The latest CDC guidelines for the HPV vaccine. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. ACS recommends cervical cancer screening with an HPV test alone every 5 years for everyone with a cervix from age 25 until age 65. Trends over time in Pap and Pap-HPV cotesting for cervical cancer screening. More than 70 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused. Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. A list of screening guidelines and other cancer resources for health care providers. Subsequently, you will only need to have the test every five years if your results are normal. Although HPV self-sampling has the potential to greatly improve access to cervical cancer screening, and there is an increasing body of evidence to support its efficacy and utility, it is still investigational in the United States 5 11 . Pap Smear Screening begins at age 21 regardless of when sexual activity starts. ACS carefully evaluated the potential benefits and harms of each screening test for each age group to come up with their updated recommendations. There is high certainty that the net benefit is substantial. A Grade D definition means that, The USPSTF recommends against the service. 10/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other . Here's how to choose your code based on time or medical decision making. And it detects a lot of minor changes that have a very low risk of turning into cancer. Screening for cervical cancer with high-risk human papillomavirus testing: updated evidence report and systematic review for the US Preventive Services Task Force. HW]o7}_&RUPJT. Persistent disparities in cervical cancer screening uptake: knowledge and sociodemographic determinants of Papanicolaou and human papillomavirus testing among women in the United States. Unless youve had a radical hysterectomy, which involves removing the uterus, cervix, ovaries, fallopian tubes, and part of the vagina, you should still get pap smears. The USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than age 30 years (D recommendation). Our Cancer Reporting Protocols are used by thousands of pathologists and other medical professionals to provide complete and uniform reporting of malignant tumors. Available studies show that precancer or cancer of the cervix is rare in women younger than age 20. Added link to 'Cervical screening: support for people who find it hard to attend'. U.S. Preventive Services Task Force. The ACOG recommends that women 30 or older get screened every 3 years with a Pap test, while women 21-29 should be screened every 5 years. . The American Cancer Societys new guideline has two major differences from previous guidelines. If HPV testing alone is not available, people can get screened with an HPV/Pap cotest every 5 years or a Pap test every 3 years. Cancer 2017;123:104450. They provide comprehensive descriptions of asthma pathogenesis, diagnosis, assessment and management, as well as specific recommendations for all patients with asthma. And knowing more about them can help ease any fears. J Natl Med Assoc 2020;112:22932. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. The adoption of the USPSTF guidelines expands the recommended options for cervical cancer screening in average-risk individuals aged 30 years and older to include screening every 5 years with primary high-risk human papillomavirus (hrHPV) testing. Cervical cytology (Pap) smear is proposed for the programme. Any person with a cervix should be screened, regardless of gender identity, sexual orientation, or sexual activity. Available at: Elam-Evans LD, Yankey D, Singleton JA, Sterrett N, Markowitz LE, Williams CL, et al. New recommendations for screening and treatment to prevent cervical cancer 6 July 2021 Departmental news Reading time: 4 min (1017 words) Too many women worldwide - particularly the poorest women - continue to die from cervical cancer; a disease which is both preventable and treatable. A Pap test looks for abnormal cells. The department would like to acknowledge the following team members: NDOH leads: Dr Pearl Holele and Dr M Makua Clinical experts: Prof. Lynette Denny, Dr Mary Kawonga and Dr Nancy Kidula 0000376559 00000 n The age that most women start menopause varies from woman to woman but typically starts between the ages of 45 and 55. A Pap smear involves collecting cells from your cervix the lower, narrow end of your uterus that's at the top of your vagina. Pap test every 3 years Updated cervical cancer screening guidelines from ACS recommend starting screening at age 25 with an HPV test and having HPV testing every 5 years through age 65. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. 0000033842 00000 n This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. Women with risk factors for cervical cancer should be screened more frequently than every three years under these guidelines as well; if you are over 30 and also have had an abnormal pap test result in the past 5 years or HPV infection, you should also get screened more frequently (every 3-5 years). Evidence from randomized, controlled trials and observational studies indicates that harms from these diagnostic procedures include vaginal bleeding, pain, infection, and failure to diagnose (due to inadequate sampling). While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. A Pap smear is a simple, quick, and essentially painless screening test (procedure) for cancer or precancer of the uterine cervix. Given these significant health equity concerns and the current suboptimal rates of cervical cancer screening and HPV vaccination, ACOG, ASCCP, and SGO continue to recommend initiation of cervical cancer screening at age 21 years. 0000013151 00000 n Because a pap smear involves testing for cervical cancer, even if youve had a partial hysterectomy, you still need to carefully monitor that part of your health. Available at: Updated Cervical Cancer Screening Guidelines, href="https://jamanetwork.com/journals/jama/fullarticle/2697704, https://academic.oup.com/ajcp/article/137/4/516/1760450, https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/10/updated-guidelines-for-management-of-cervical-cancer-screening-abnormalities, https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.3.aspx, https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21628, : https://jamanetwork.com/journals/jama/fullarticle/2697702, https://jamanetwork.com/journals/jama/fullarticle/2697703, https://www.cdc.gov/cancer/hpv/statistics/cervical.htm, https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.30507, https://www.sciencedirect.com/science/article/abs/pii/S0027968420300432, https://gh.bmj.com/content/4/3/e001351.long, https://jamanetwork.com/journals/jamaoncology/fullarticle/2554749, https://www.cdc.gov/mmwr/volumes/70/wr/mm7012a2.htm, https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a1.htm, https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08, https://www.tandfonline.com/doi/abs/10.1080/13557858.2018.1427703, https://www.liebertpub.com/doi/10.1089/jwh.2018.7380, https://www.cdc.gov/mmwr/volumes/70/wr/mm7002a1.htm, https://journals.sagepub.com/doi/10.1177/0033354920925094, https://journals.lww.com/greenjournal/Fulltext/2020/08000/Human_Papillomavirus_Vaccination__ACOG_Committee.48.aspx, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. Three options are available: A Pap test every 3 years, human papillomavirus (HPV . Sources: US Preventive Services Task Force (USPSTF) (for hysterectomy), American College of Obstetrics and Gynecology (ACOG) (for age). For patients aged 25 and older, a reflex hrHPV test is performed when Pap results are ASC-US (atypical squamous cells of undetermined . Acog PAP Guidelines Algorithm 2020 PDF Overview The American Congress of Obstetricians and Gynecologists (ACOG) has released new guidelines for cervical cancer screening. Download ASCCP Management Guidelines and enjoy it on your iPhone, iPad, and iPod touch. Although cervical cancer screening options have expanded, cervical cytology, primary hrHPV testing, and co-testing are all effective in detecting cervical precancerous lesions and cancer. They will then examine it under a microscope in order to detect any abnormal changes in your cervical cells that could be cancerous or pre-cancerous lesions (precancers). These women should have follow-up testing and cervical cancer screening as recommended by their health care team. National Cervical Screening Program Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding GUIDELINE UPDATES - This guideline was last updated 30/06/2022 Changes to the National Cervical Screening Program Guidelines to support universal self-collection All three tests can find cervical cancer precursors before they become cancer. 30-65. Although cytology-based screening options are still included in the ACS guidelines in acknowledgement of these barriers to widespread access and implementation, ACS strongly advocates phasing out cytology-based screening options in the near future 5 . But there are current efforts to study the age limit more because its an area where we have less data. 0000140435 00000 n Primary hrHPV testing uses high-risk HPV testing alone (no cytology) with a test that is approved by the U.S. Food and Drug Administration (FDA) for stand-alone screening. 0000016334 00000 n JAMA 2018;320:687705. Pap Smear Laboratory Testing May 06 2021 Adult-Gerontology Practice Guidelines Jan 02 2021 The first book to encompass adult-gerontology practice guidelines for primary care, this is a comprehensive resource designed for health care practitioners taking the new Adult-Gero NP certification course and exam. Using information from new studies, ACS concluded that the benefits of cervical cancer screening do not outweigh the harms for people aged 21 to 24 years old. The Pap test has been the mainstay of cervical cancer screening for decades. 168, October 2016) Choose a diagnosis to view recommended management. Then the doctor uses a brush or swab to collect cells to test. 0000019995 00000 n Both tests can be done in a doctor's office or clinic. (Replaces Practice Bulletin No. Instead of an annual pap, you can get oneevery three yearsuntil youre 65. They are not a substitute for individual . Inadequate cervical cancer screening remains a significant problem in the United States, with persistent health inequities across the entire spectrum of cervical cancer care 10 17 19 . 0000009772 00000 n Practice Advisory. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. For more information on the USPSTF grades, see https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions Primary hrHPV testing is FDA approved for use starting at age 25 years, and ACOG, ASCCP, and SGO advise that primary hrHPV testing every 5 years can be considered as an alternative to cytology-only screening in average-risk patients aged 2529 years. Pap and HPV tests fact sheet (PDF, 267 KB) Pap and HPV tests Pap tests (or Pap smears) look for cancers and precancers in the cervix. Available at: American College of Obstetricians and Gynecologists. The new iOS& Android mobile apps and the Web application,to streamline navigation of the guidelines, have launched. This allows him or her to get a closer look at your cervix as well as collect samples from different parts of it using swabs called cytobrushes (or Pap brushes). A pap smear is a test thats conducted during a pelvic exam. Some of those include: Pap smears typically take place during a gynecological pelvic exam. However, few Canadian data exist on HR HPV self-sampling. 1.Introduction. Available at: MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, Wilson PM, Jacobson DJ, Fan C, et al. Copyright 2023 American Academy of Family Physicians. Read the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors, access the mobile app, and refer to the historical 2012 and 2006 guidelines. Other HPV tests are approved as part of an HPV/Pap cotest. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. And if you have an incorrect result, you may end up getting unnecessary follow-up tests or even unnecessary treatment. Table 1. HPV vaccines are very good at preventing HPV infections, particularly infection with HPV types 16 and 18, the types that cause most cervical cancers. They also recommend that women over 30 whove had negative tests for HPV at least 3 times in a row can stop getting them altogether (but if youre over 30 and havent had a negative test for HPV yet, keep getting tested!). 0000024248 00000 n There are a few risks that come with cervical cancer screening tests. We also have seen great development of new technologies like HPV testing and improvement in some of the secondary tests that are used for following up after screening. Available at: Kim JJ, Burger EA, Regan C, Sy S. Screening for cervical cancer in primary care: a decision analysis for the US Preventive Services Task Force. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America Published CID, 12/8/2021 Clinical Infectious Diseases, Volume 73, Issue 11, 1 December 2021, Pages e3572-e3605, https://doi.org/10.1093/cid/ciaa1391 Human papillomavirus (HPV), a sexually transmitted disease, is identified as the source of 99.7% of cervical cancers. PAP Education Program. 0000030653 00000 n Saslow D, Runowicz CD, Solomon D, et al. Vaginal Smears Young Adult . A pap smear is a routine screening test that checks for cancers or pre-cancerous cells in your cervix, which is the bottom part of your uterus. It also allows your doctor to determine if treatment or further testing should be needed. ET). 214 29 Increase the proportion of adolescents who get recommended doses of the HPV vaccineIID 08. Organization (WHO) guidelines, the cervical prevention and control policy, 2017 document is aligned to the healthcare situation in South Africa. And knowing more about them can help ease any fears. www.acog.org. The purpose of this test is to screen for cervical cancer, precancers, and other abnormalities that can occur in womens vaginas. Once stopped, it should not be started again. New 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors provide new . The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. endstream endobj startxref American Cancer Society guideline for the early. Raising the screening start age to 25 years could increase the already high rate of underscreening among individuals aged 2529 years and exacerbate existing health inequities in cervical cancer screening, incidence, morbidity, and mortality 10 17 18 19 . Thats why ACS recommends starting screening at age 25. Grade A denotes that The USPSTF recommends the service. But the analysis of pap smear slides is a time-consuming task and tedious as it requires ma. For an HPV/Pap cotest, an HPV test and a Pap test are done together. Addition of 'cervical screening: disclosure of audit toolkit' to the audit section. Cervical cancer develops slowly, so it makes sense to wait until a woman reaches adulthood before beginning regular Pap testing. Most doctors still recommend that all women get a pap smear every three years, until they are 65 to 70, regardless of if theyre in menopause or postmenopausal. Some women experiencebleeding after a pap smear. The cervix is part of the female reproductive system that connects the uterus to the vagina. It is not intended to substitute for the independent professional judgment of the treating clinician. [PDF-169KB] that can be used by health departments for determining the need to further assess an unusual pattern of cancer. These recommendations are in line with those of the World Health Organization (WHO), which says that all women should start getting annual Paps at age 25, and then switch to every 3 years starting at age 30. What is a Pap Smear? For most women, the worst part of going to the gynecologist is getting a pap smear. Clinical Practice Listserv (Members Only), Colposcopy Education Completion Program (formerly CMP), new iOS& Android mobile apps and the Web application. The recommended age limit for cervical cancer screening has been consistent across different guidelines over the years. American College of Obstetricians and Gynecologists National Cervical Screening Program - Changes to the clinical management of women at intermediate risk - frequently asked questions Label conventional slides on the frosted end using a graphite pencil (NOT a pen, marker, wax pencil or crayon). Most doctors recommend that women or people who were assigned female at birth get a pap smear once every 3-5 years, starting at age 21. Adequate negative prior screening test results are defined as three consecutive negative cytology results, two consecutive negative cotesting results, or two consecutive negative hrHPV test results within 10 years before stopping screening, with the most recent test occurring within the recommended screening interval for the test used (1, 5). Healthy People 2030. A Pap smear, also called a Pap test, is a test used to detect abnormal cells on the cervix that are cancerous or may become cancerous. Am J Clin Pathol 2012;137:51642. Patients with any specific questions about this recommendation or their individual situation should consult their physician. On Jan. 1, 2021, you will need to start choosing the appropriate level of evaluation and management (E/M) established and new patient outpatient codes based on new E/M guidelines. Public Health Rep 2020;135:48391. See the full list of organizations (below) that participated in the consensus process. By detecting these conditions early on through regular screening, you can take steps to prevent them from progressing and spreading into other parts of the body which means it could even save your life! Women screened for the first time at age 55 or more will have only one smear if first smear is normal. Screening people in this age group often leads to unnecessary treatment, which can have side effects. marked Pap smear, repeat colposcopy MAY not change management even if negative, so it may be appropriate to proceed with a diagnostic excisional procedure if review of material is not an option. Read Online Acog Guidelines For Pap Smears 2014 Pdf Free Copy The Bethesda System for Reporting Cervical Cytology European Guidelines for Quality Assurance in Cervical Cancer Screening 5 Yearly HPV Tests . For an HPV/Pap cotest, an HPV test and a Pap test are done together. The cervix is the lower, narrow end of the uterus that opens into the vagina. Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. 0000014887 00000 n No, the recommendations for this age group are the same as before. The abnormal changes are called dysplasia; over time, these changes may progress to cervical cancer if left untreated. This is normal and happens because pap smears can irritate the blood vessels surrounding the cervix, but usually stop within a few days. This practice has shifted in the last few years. 1.Uterine cervical neoplasms - prevention and control. Pap smears should then be done every 3 years until they are 29. 104 0 obj <> endobj A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. Cervical Screening Guidelines Summary This information also available as a PDF download. Cervical cancer testing (screening) should begin at age 25. Studies using immunohistochemistry have associated the loss of certain capsid proteins in ASC-US specimens with progression to a more severe form of . Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Yes, the new guideline recommends screening for those who have had the HPV vaccine. The first cohort of women who received the HPV vaccine when they were younger are now in their 20s and are eligible for cervical cancer screening. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis. Cervical cancer prevention, screening, and treatment are critical components of comprehensive reproductive health care. Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services, Pap test every 3 years, HPV test every 5 years, or HPV/Pap cotest every, No screening if a series of prior tests were normal, No screening if a series of prior tests were normal and not at high risk for cervical cancer. The dual stain test uses two biomarkers that can give a more accurate sign that precancer is present. The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer (D recommendation). A Practice Advisory is a brief, focused statement issued to communicate a change in ACOG guidance or information on an emergent clinical issue (eg, clinical study, scientific report, draft regulation). The cervix is the lower part of the uterus that connects to the vagina. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. If something abnormal or suspicious was found, also called a positive test result, you will typically get a second test. Theres alsothe possibility of added anxiety and other emotions from incorrect, or false-positive, test results. at the National Institutes of Health, An official website of the United States government, ACSs Updated Cervical Cancer Screening Guidelines Explained, an updated guideline for cervical cancer screening, Division of Cancer Epidemiology and Genetics, a type of screening test called an HPV test, US Preventive Services Task Force (USPSTF) in 2018, abnormal cells that can lead to cancer in the cervix, we have amazing results from the HPV vaccine, the secondary tests that are used for following up after screening, a new FDA-approved test, called dual stain, Drug Targets Common Mutation in Pancreatic Cancer. Consistent with prior guidance, screening should begin at age 21 years, and screening recommendations remain unchanged for average-risk individuals aged 2129 years and those who are older than 65 years Table 1. Most doctors still recommend that all women get a pap smear every three years, until they are 65 to 70, regardless of if they're in menopause or postmenopausal. The difference in the new ACS guidelines is that they elevate HPV testing alone over the other two tests. Screening tests and follow-up tests can cause physical discomfort. NCI Division of Cancer Epidemiology & Genetics. Skip directly to site content Skip directly to search. H\0 !eE/j@I@,'qwn}&1 !mj9s'yaWs$u}4O}xy1>'S8&3UexD.^>|>FS,9enT*SJb8xj~SR_,c]{Er [|=)3[OIiiisr.=X}%*;0d\s90cCcCcCw`ug_}=zxxxxxxx y,d No. There is more interest now in looking at people who had an abnormal screening test result at an older age to see if they require more years of screening or more frequent screening. ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. In the past, ACOG recommended women start Pap testing at age 18and some doctors followed this recommendationbut many experts argued that starting Pap tests too early would lead to more false positive results and unnecessary treatments. For a patient at the doctors office, an HPV test and a Pap test are done the same wayby collecting a sample of cervical cells with a scraper or brush. BMJ Glob Health 2019;4:e001351. 3.Precancerous conditions - therapy. The new guidelines are based on the most recent scientific evidence and take into account the latest HPV vaccines. So, many people who get an abnormal Pap test result actually have a very low chance of developing cervical cancer. Available at: Buskwofie A, David-West G, Clare CA. During a Pap smear, a health care provider collects cells from the cervix and sends them to a lab. The harms of treatment also could include risks from the treatment procedure (such as cold-knife conization and loop excision) which are associated with adverse pregnancy outcomes, such as preterm delivery, that can lead to low birth weight in infants and perinatal death. ACOG guidelines for cervical cancer screening, Obstet Gynecol 2006; 107 . According to the U.S. Preventative Services Task Force and the American Congress of Obstetricians and Gynecologists, women should begin getting Pap smears at age 21 and get another . One is to start screening at a slightly older age, and the other is to preferentially recommend a type of screening test called an HPV test. The specific strategy selected is less important than consistent adherence to routine screening guidelines. (Monday through Friday, 8:30 a.m. to 5 p.m. 0000136927 00000 n Cells collected from a woman's cervix during a pelvic exam are spread on a microscope slide for examination. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Now, doctors can use any combination of test results to determine an individuals risk and decide whether that person should, for example, get a colposcopy or come back in a year to repeat the screening test. For additional quantities, please contact [emailprotected] Save my name, email, and website in this browser for the next time I comment. HPV-associated cervical cancer rates by race and ethnicity. JAMA 2018;320:67486. Cervical Screening Guidelines Summary Guidelines & Advice About Guidelines Email Guidelines Team Recommendations for Follow-Up of Abnormal Cytology This information is also available in this [ PDF download ]. Printable versions of the standards (in Word or PDF formats) are available for free. HPV tests are a newer method of cervical cancer screening. With recent shifts in guideline-recommended cervical cancer screening tests (e.g., Papanicolaou (Pap) and/or human papillomavirus (HPV) testing),(Curry et al., 2018, Fontham et al., 2020) as well as the Healthy People 2030 goals for U.S. screening coverage,(Office of Disease Prevention and Health Promotion.Healthy People, 2030) it is important to have accurate measures of . This description is from Documentation Guidelines for Evaluation and Management Services, published in May 1997 and was developed by the Centers for Medicare & Medicaid Services and the American Medical Association. The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years (A recommendation).