ACOG guidelines support co-testing and genotyping for HPV types 16 and 18.
ACOG on co-testing with genotyping1
- Co-testing using the combination of Pap cytology plus HPV DNA testing is the preferred cervical cancer screening method for women 30-65 years old. Any low-risk woman between 30-65 years old who receives negative test results on both Pap cytology screening and HPV DNA testing should be rescreened in 5 years.
- Immediate HPV genotype-specific testing for HPV 16 alone or HPV 16/18 can be used as an adjunct in women with negative Pap test results, but who have tested positive for hrHPV by an assay testing for 13 or 14 high-risk types.
- Women who test positive for HPV 16 or HPV 16/18 should be referred directly for colposcopy.
- Women with negative results for HPV 16 or HPV 16/18 should be co-tested in 12 months.
ACOG guidelines summary
The following recommendations are based on good and consistent scientific evidence (Level A):1
- Cervical cancer screening should begin at age 21 years.
- Pap cytology screening is recommended every 3 years for women between the ages of 21 years and 29 years.
- For women aged 30-65 years, co-testing with cervical cytology screening and HPV testing is preferred and should be performed every 5 years.
- For women aged 30-65 years, screening with cytology alone every 3 years is acceptable.
- Both liquid-based and conventional methods of Pap cytology are acceptable for screening.
- In women who have had a total hysterectomy and have never had CIN2 or higher, routine cytology screening and HPV testing should be discontinued and not restarted for any reason.
- Women who have a history of cervical cancer, have HIV infection, are immunocompromised, or were exposed to diethylstilbestrol in utero should not follow routine screening guidelines.
- Screening by any modality should be discontinued after age 65 years in women with evidence of adequate negative prior screening results* and no history of CIN2 or higher.
CIN: Cervical Intraepithelial Neoplasia
- The American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists: Screening for Cervical Cancer. November, 2012.