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Eligibility


Average risk screening start age

Cervical cancer screening should begin at age 25. Evidence suggests four well founded reasons for initiating screening at age 25:

  • Invasive cervical cancers in women younger than age 25 are rare;
  • Screening is relatively ineffective in younger women;
  • Women under 25 have a higher prevalence of lesions that often clear without treatment;
  • There are risks associated with unnecessary follow-up and treatments, many of which may have long-term consequences for pregnancy or cause undue anxiety and distress.

Average risk screening interval

Average risk women between the ages of 25-69 should be screened every three years.

Average risk screening stop age

Screening can stop at age 69 if results have always been normal.

Higher than average risk screening recommendations

Immunocompromised individuals and those previously treated for dysplasia are considered at high risk of developing cervical cancer and should be screened annually. Individuals currently being assessed by a colposcopy clinic or being followed by a cancer clinic should not undergo additional cervical cancer screening unless directed by the treating physician.

For more information on higher than average risk screening recommendations, please refer to the Screening Recommendations for Individuals at High Risk of developing cervical cancer.

Frequently asked questions

Individuals who have received the HPV vaccine still require cervical cancer screening because the vaccine does not protect against all types of HPV that can cause cervical cancer.


For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 
Evidence suggests four well founded reasons for initiating screening at age 25:

  • Invasive cervical cancers in women younger than age 25 are rare;
  • Screening is relatively ineffective in younger women;
  • Women under 25 have a higher prevalence of lesions that often clear without treatment;
  • There are risks associated with unnecessary follow-up and treatments, many of which may have long-term consequences for pregnancy or cause undue anxiety and distress.

For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 

Evidence, including BC data, demonstrates that cytology testing every three years is just as effective and safe as annually or biannually.


For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 

While cervical cancer screening has proven very effective in decreasing the incidence of pre-cancer and cervical cancer, like any screening test, it isn’t perfect. Women should be aware of the benefits and harms of cervical cancer screening and make an informed decision to screen.

Benefits of Screening

  • Screening where practiced effectively, has resulted in decreased cervical cancer incidence and mortality in women (1,2). 

  • Cervical cancer is one of the most preventable cancers. Cervical cancer begins as an infection of the uterine cervix with high risk human papillomavirus (hr-HPV) that needs to persist for many years. The transition from initial HPV infection to invasive cancer seems to take decades in most cases, with a minimal latency period of approximately 7 years (3,4).
  • Cervical cancer screening saves lives. Most cervical cancer cases occur among women who have not undergone screening or who have had a long interval between Pap tests. In BC, about 58% of the 178 patients diagnosed with invasive cervical cancer in 2014 were five years or more overdue for screening (5). The majority of cases are diagnosed in the 30-39 and 40-49 age groups (5).
  • Women between the ages of 25-69 stand to benefit the most from screening.

Harms of Screening

  • Most HPV infections and pre-cancerous lesions resolve spontaneously, particularly among younger women who are of childbearing age (6,7).
  • Over-diagnosis and treatment of these transient cervical intraepithelial neoplasia (CIN) is associated with substantial harms, including heightened psychosocial consequences in the women treated (8), increased risk of pre-term and low-birth weight babies (especially for women treated with excisional approaches) (9,10) and unneccesary utilization of health care resources.
  • A 2008 study concluded that in the treatment of CIN, all excisional procedures seem to be associated with adverse obstetric morbidity, but among these, only cold knife conisation is associated with a significantly increased rate of severe outcomes (11).
  • Initiating screening in women under 25 can produce more harm than benefit, as cervical cancer is not common in women under age 25. 

For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.


(1) Arbyn M, Raifu AO, Bray F, Weiderpass E, Anttila A.Trends of cervical cancer mortality in the member states of the European Union. European Journal of Cancer 2009;45:2640–8.

(2) Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318(7188):904–8.

(3) Hildesheim A, Hadjmichael O, Schwartz P, et al.: Risk factors for rapid onset cervical cancer. Am J Obstet Gynecol 1999;180:571-577.

(4) Liebrich C, Brummer O, Von WR, et al.: Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. Eur J Gynaecol Oncol 2009;30:45-48.

(5) 2016 Cervical Cancer Screening Program Annual Report, BC Cancer Agency, www.screeningbc.ca

(6) Woodman CB, Collins SI and Young LS. The natural history of cervical HPV infection: unresolved issues. Nature Reviews: Cancer. 2007; 7(1): 11-22.

(7) Kulasingam S, Havrilesky L, Ghebre R et al. Screening for Cervical Cancer: A Decision Analysis for the U.S. Preventive Services Task Force. 2011. Available at http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcanceres.pdf. Accessed January 2012.

(8) Fylan F. Screening for cervical cancer: a review of women's attitudes, knowledge, and behaviour. The British Journal of General Practice. 1998; 48(433): 1509-14.

(9) Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2010(6):CD001318.

(10) Kristensen J, Langhoff-Roos J and Kristensen FB. Increased risk of preterm birth in women with cervical conization. Obstetrics and Gynecology. 1993; 81(6): 1005-8.

(11) Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, Prendiville W, Paraskevaidis E. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ. 2008 Sep 18;337:a1284

 
For average risk patients under age 25 we now recommend a repeat Pap test in 36 months or upon reaching the age of 25 – whichever occurs later.

However, for patients under 25 with a previous abnormal Pap, where the lab report indicates repeat screening in six months, we recommend continuing to follow guidelines for abnormal results.  If they are being followed for a low grade abnormality (ASC-US/LSIL) they will need a total of two repeat cervical cancer screening tests at 6 monthly intervals.  They can return to routine follow up if results from both tests are normal.  Routine follow up will be a repeat test in 36 months or upon reaching the age of 25 – whichever occurs later.  

Regardless of age, if the previous recommendation was for colposcopy follow-up, please continue to arrange for colposcopic follow-up.
 
If the recall reminder recommends re-screening in 12 or 24 months for an average risk patient between the ages of 25-69, please follow the new cervical cancer screening guidelines and repeat screening at 36 months.
 




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