Cervical Cancer Screening!

Rumara comes to the office at age 32yo for her first physical since age 18yo. She doesn’t think she has received the HPV vaccination. She wants to know about screening options. She also is recently divorced and hoping to become more sexually active.

HPV HISTORY

HPV 9-valent vaccine 

Per Advisory Committee on Immunization Practices, the vaccine is RECOMMENDED FOR:
1. Males/Females at age 11-12yo, but can start as early as age 9yo!
2.13-26yo for catch-up / initial vaccination

What about for Rumara?
– 27-45yo based on shared decision-making

SCREENING GUIDELINES

USPSTF (2018)

• Age <21yo:
  • Don’t do it unless HIV+
• Age 21-29:
  • Cytology from Pap every 3 years
• Age 30-64:
  • Cytology with Pap every 3 years
  • HPV Testing every 5 years
• Age >65:
  • Stop if adequately screened: 3x pap negative or 2x HPV negative so last 10 years

ACS (2020)

• Age <25yo:
  • Don’t do it unless HIV+
• Age 25-65:
  • HPV alone ever 5 years (highly recommended)
  • Cytology with Pap every 3 years
  • Co-Testing
• Age >65:
  • Same as USPSTF

*HPV vs Pap: Think about if patient has anxiety may be better to test every 3 years

OTHER CONSIDERATIONS

• Hysterectomy
  • Pre-cancerous or cancerous lesion
    • Yes: Vaginal swab
    • No: No further screening
• Partial Hysterectomy
  • Cervix still there?
    • Normal screening

WHAT WOULD YOU DO?

Q: What would you do if you do a pap and the result says

• Negative screening cytology and absent endocervical cells/transformation zone component
• Atypical squamous cells of undetermined significance 

A: Two options:

• Reflex HPV
  • If positive: colposcopy
  • If negative: repeat in 3 years
• Repeat pap in 1 year

Q: What would you do if the pap result says LSIL?

A: Repeat pap in 1 year or colposcopy 

HPV TESTING

Let’s say we do HPV testing. What are the next steps if testing is positive? 

*Blog post based on Med-Peds Forum talk by Madeleine Ward, PGY1