Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Elizabeth T. H. Fontham, MPH, DrPH1; Andrew M. D. Wolf, MD2; Timothy R. Church, PhD3; Ruth Etzioni, PhD 4,5; Christopher R. Flowers, MD, MS 6; Abbe Herzig, PhD7; Carmen E. Guerra, MD 8; Kevin C. Oeffinger, MD 9;
Ya-Chen Tina Shih, PhD 10; Louise C. Walter, MD 11,12; Jane J. Kim, PhD13; Kimberly S. Andrews, BA14;
Carol E. DeSantis, MPH 15; Stacey A. Fedewa, PhD, MPH15; Deana Manassaram-Baptiste, PhD, MPH14;
Debbie Saslow, PhD14; Richard C. Wender, MD 16; Robert A. Smith, PhD 14

Abstract: The American Cancer Society (ACS) recommends that individuals with a
cervix initiate cervical cancer screening at age 25 years and undergo primary human
papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary
HPV testing is not available, then individuals aged 25 to 65 years should be
screened with cotesting (HPV testing in combination with cytology) every 5 years
or cytology alone every 3 years (acceptable) (strong recommendation). The ACS
recommends that individuals aged >65 years who have no history of cervical intraepithelial
neoplasia grade 2 or more severe disease within the past 25 years,
and who have documented adequate negative prior screening in the prior 10 years,
discontinue all cervical cancer screening (qualified recommendation). These new
screening recommendations differ in 4 important respects compared with the 2012
recommendations: 1) The preferred screening strategy is primary HPV testing every
5 years, with cotesting and cytology alone acceptable where access to US Food
and Drug Administration-approved primary HPV testing is not yet available; 2) the
recommended age to start screening is 25 years rather than 21 years; 3) primary
HPV testing, as well as cotesting or cytology alone when primary testing is not available,
is recommended starting at age 25 years rather than age 30 years; and 4) the
guideline is transitional, ie, options for screening with cotesting or cytology alone are
provided but should be phased out once full access to primary HPV testing for cervical
cancer screening is available without barriers. Evidence related to other relevant
issues was reviewed, and no changes were made to recommendations for screening
intervals, age or criteria for screening cessation, screening based on vaccination
status, or screening after hysterectomy. Follow-up for individuals who screen positive
for HPV and/or cytology should be in accordance with the 2019 American Society for
Colposcopy and Cervical Pathology risk-based management consensus guidelines
for abnormal cervical cancer screening tests and cancer precursors. CA Cancer J
Clin 2020;0:1-26. © 2020 American Cancer Society.
Keywords: cervical neoplasms, cervix neoplasms, guideline, mass screening,
prevention and control


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