Can the new cervical cancer screening and management guidelines be simplified?

Abstract

Effective cervical cancer prevention relies on frequent screening and appropriate management of abnormal test results to prevent cells with precancerous changes from progressing to cancer. Historically, guidelines were simple and clear: screen annually with Papanicolaou (Pap) tests, evaluate abnormal results with colposcopy and diagnostic biopsy, treat most abnormal results by means of either excision (loop excision) or ablation (cryosurgery), and then resume annual Pap testing. This approach was simple and easy to implement, but it led to overevaluation and overtreatment of many women still in their childbearing years. In 2012, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology 1 and the US Preventive Services Task Force, 2 after reviewing extensive data related to cervical cancer screening, cancer risk, and age, issued new screening guidelines. These guidelines were developed through a rigorous process consistent with recommendations from the Institute of Medicine and were also relatively easy to implement. They recommend initiating screening with a Pap test when women are 21 years old, regardless of sexual history, and continuing screening at 3-year intervals with Pap testing alone if all test results remain nor