New Insights into Cervical Cancer Screening Guidelines in the United States, 2012

With knowledge of the pathogenesis of cervical cancer in the last decade, we are always improving the strategy for cervical cancer screening. Both of ACS/ASCCP/ASCP group and the USPSTF and ACOG released their new guidelines in 2012. We review these recommendations and the possible future direction of screening.In their guidelines for cervical cancer screening in 2012, several organizations call for less frequent but more effective screening which incorporates testing for human papillomavirus (HPV). The new guidelines still recommend starting screening with cytologic (Papanicolaou) testing at age 21, but with longer screening intervals, women with age 21 to 29 are recommended screening every 3 rather than 2 years, and women with age 30 and older screened by combined cytologic and HPV testing should be rescreened every 5 years if both test results are negative. The new guidelines recommend stopping screening in advance at age 65 if they have had adequate screening until then with no history of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in the past 20 years. The new guidelines now recommend HPV 16/18 genotyping as a triage option in women who have positive results on HPV testing but negative cytology results, and immediate referral for colposcopy if the genotyping test is positive. It can help to identify those at higher risk of developing CIN2+. They reaffi rm their recommendation about stopping screening after hysterectomy with removal of the cervix for a reason except who have had history of CIN2+ or cervical cancer. Screening should not be changed after HPV vaccination. Combined cytologic and HPV testing has received its strongest endorsement to date in their latest guidelines. And the novel biomarkers such as p16 and Ki-67 expression has been found helpful for clinician in deciding which women who have positive HPV but negative cytology results should be referred for colposcopy. With the latest cervical cancer screening guidelines, we can implement a more sensitive and effective screening strategy for better prevention and early detection of cervical cancer.