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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.
*Adequate negative prior screening results are defined as three consecutive negative cytology results or two consecutive negative co-test results within the previous 10 years, with the most recent test performed within the past 5 years.
ACOG: American Congress of Obstetricians and Gynecologists
CIN: Cervical Intraepithelial Neoplasia

REFERENCES:

  1. The American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists: Screening for Cervical Cancer. November, 2012.