For cervical cancer in women who have been sexually active and have a cervix, USPSTF recommends screening within 3 years of onset of sexual activity or by age 21, whichever comes first, and screening at least every 3 years. They recommend against the use of routine Pap tests in low-risk women older than 65 years and in women who have had a hysterectomy for benign reasons (USPSTF, 2003). The AAFP (2008) endorses this recommendation. ACOG (2009) recommends starting at age 21 with screening every 2 years, then every 3 years for women over age 30 with three consecutive normal Pap smears. The ACS recommends initiating screening

3 years after a woman becomes sexually active or at age 21, with annual Pap tests (or biannual tests if using liquid-based preparation) until age 30 and then every 2 to 3 years thereafter (Hartman et al., 2002).

The USPSTF does not currently have recommendations regarding HPV vaccination. ACOG recommends HPV vaccination of females age 9 to 26 years against HPV. The ACS recommends beginning HPV vaccination series as early as 9 years at the discretion of the physician, with the understanding that it is still necessary to continue screening with the Pap test at the appropriate intervals even with the history of HPV vaccination.

The American Society for Colposcopy and Cervical Pathology suggests an option of using HPV screening as an adjunct to Pap smears in women age 30 and older. If HPV testing is negative, Pap smears can be spaced to every 3 years; however, if HPV screening is positive, Pap and HPV testing could be repeated in 1 year. ACOG endorses this option of using HPV testing as an adjunct in women 30 years and older.

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