American Society for Colposcopy and Cervical Pathology

View all recommendations from this society

February 14, 2017

Don’t perform annual cervical cytology (Pap test) or annual HPV screening of immunocompetent women with a history of negative screening.

There is a slight increase in cancer risk by increasing the interval between screens. However, this risk is balanced with potential harm from more colposcopy as a result of spurious HPV infection that, in most women, will clear spontaneously and is unlikely to progress to any clinically relevant cervical disease. Based on modeling studies of 3- or 5-year intervals, the screening intervals should be greater than a year, but the current evidence does not support a longer screening interval than 3 years for cervical cytology with HPV triage or for primary HPV screening with cytology triage.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

As a national medical specialty society with membership across multiple disciplines and differing healthcare providers, including doctors and advanced practice nurses, the ASCCP (The Society for Lower Genital Tract Disorders) relies on input from its committee structure and governance for document development. For the Choosing Wisely campaign, the list was obtained through expert discussion of members of the Practice Committee. A literature search was conducted related to each item. The list was then ratified by the Society’s Executive Committee and Chief Medical Officer. Due to the complexity of language around cervical cancer screening, several items use more than one term to describe the same concept (i.e., cervical cytology/Pap test, and high-grade cervical dysplasia/CIN 2/3). This was done intentionally to avoid confusion, and the statements include all terms thought to be important by members of the ASCCP. All comments from the Executive committee were incorporated into the final approved list.

Sources

Stout NK, Goldhaber-Fiebert JD, Ortendahl JD, Goldie SJ. Trade-offs in cervical cancer prevention: balancing benefits and risks. Arch Intern Med. 2008; 168:1881–1889.

Kulasingam, S.; Havrilesky, L.; Ghebre, R.; Myers, E. Screening for Cervical Cancer: A DecisionAnalysis for the US Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2011. AHRQ Publication No.11-05157-EF

American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology.

Am J Clin Pathol. 2012 Apr;137(4):516-42.
CA Cancer J Clin. 2012 May-Jun;62(3):147-72.
J Low Genit Tract Dis. 2012 Jul;16(3):175-204.