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Cervical Cancer Screening Tool
Jan 31, 2017
•
Mark Morgan
categories:
Female Health
Cervical Cancer Screening Tool
Screening Recommendation
Pap and HPV Test Interpretation
<-- Purpose
Less than 21
21 to 24
25 to 29
30 to 34
35 to 65
Greater than 65
<-- Age
Risk Assessment:
No
Yes
<-- History of abnormal screening
No
Yes
<-- Unknown screening history
No
Yes
<-- Previous HPV-related disease
No
Yes
<-- New partners
No
Yes
<-- Current smoker or history of smoking
No
Yes
<-- Immunocompromised
No
Yes
<-- In utero diethylstilbestrol exposure
Prior Screening:
Yes
No
<-- Two negative consecutive co-tests OR Three negative Pap tests within the past 10 years
Yes
No
<-- Most recent test within the previous five years
Recommendation -->
suggestion
score=(Qage)+(Qrisk1)+(Qrisk2)+(Qrisk3)+(Qrisk4)+(Qrisk5)+(Qrisk6)+(Qrisk7)+(Qprior1)+(Qprior2);score>4999?'Begin screening with Pap Test at age 21':score>2999?'Pap Test every 3 years is recommended':score>999?'Co-testing with Pap Test and HPV Testing every 5 years is recommended':score>200?'Inadequate prior screening with risk factors - Continued screening is recommended':score>199?'Inadequate prior screening with no risk factors - Continued screening is recommended':score>100?'Inadequate prior screening with risk factors - Continued screening is recommended':score>99?'Inadequate prior screening with no risk factors - Continued screening is recommended':score>0?'Adequate prior screening with risk factors - Continued screening is recommended':'Adequate prior screening with no risk factors - Consider discontinuation of screening'
Recommendation -->
suggestion
score2=(Qage);score2>4999?'Begin screening with Pap Test at age 21':score2>2999?'Pap Test every 3 years is recommended':score2>999?'Co-testing with Pap Test and HPV Testing every 5 years is recommended':score2>200?'Inadequate prior screening with risk factors - Continued screening is recommended':score2>199?'Inadequate prior screening with no risk factors - Continued screening is recommended':score2>100?'Inadequate prior screening with risk factors - Continued screening is recommended':score2>99?'Inadequate prior screening with no risk factors - Continued screening is recommended':score2>0?'Adequate prior screening with risk factors - Continued screening is recommended':'Adequate prior screening with no risk factors - Consider discontinuation of screening'
Unsatisfactory Cytology
Cytology negative, EC/TZ absent or insufficient
Cytology negative
Atypical Squamous Cells of Undetermined Significance - ASC-US
Low-grade Squamous Intraepithelial Lesion - LSIL
Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H
High-grade Squamous Intraepithelial Lesions - HSIL
Atypical Glandular Cells - AGC
<-- Cytology Result
Recommendation --> Repeat cytology after 2-4 months - OR - Colposcopy may be performed if HPV positive. See
Unsatisfactory cytology age 30 and over
Recommendation --> Repeat cytology after 2-4 months. See
Unsatisfactory cytology age 21 to 29
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. You may consider repeating cytology at age 21 or in 12 months, whichever comes later.
Recommendation --> Further action is based on the HPV result. See
EC/TZ absent age 30 and over
Recommendation --> Continue routine screening with Pap Smear (cytology only) every 3 years.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. You may consider repeating cytology at age 21 or in 12 months, whichever comes later.
Unknown
Negative
Positive
<-- What is the HPV result?
Recommendation --> Continue routine screening with Pap smear (cytology only) every 3 years or Co-Testing (cytology and HPV testing) every 5 years. Consider discontinuing screening if patient has had adequate prior screening and is not high risk.
Recommendation --> Repeat cotesting at 1 year -OR- HPV DNA typing now is acceptable. See
HPV positive age 30 and over
Unknown
Negative
Positive
<-- What is the HPV result?
Recommendation --> Continue routine screening with Pap smear (cytology only) every 3 years or Co-Testing (cytology and HPV testing) every 5 years.
Recommendation --> Repeat cotesting at 1 year -OR- HPV DNA typing now is acceptable. See
HPV positive age 30 and over
Recommendation --> Screen every 3 years with cytology.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. You may consider repeating cytology at age 21 or in 12 months, whichever comes later.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.
Recommendation --> Either Reflex HPV Testing (acceptable) or Repeat Cytology at 12 months (preferred) may be performed.
Reflex HPV Testing
Repeat Cytology
<-- Which follow-up study is chosen?
Negative
Positive
<-- What is the reflex HPV result?
Recommendation --> Repeat Cytology at 12 months. See
Women age 21-24 with ASC-US
Recommendation --> Resume routine screening.
Recommendation --> Repeat Cytology at 12 months. See
Women age 21-24 with ASC-US
Recommendation --> Either Repeat Cytology at 12 months (acceptable) or HPV Testing (preferred) may be performed.
Repeat Cytology
HPV Testing
<-- Which follow-up study is chosen?
Negative
ASC-US, LSIL, ASC-H, AGC, or HSIL
<-- What is the follow up cytology result at 12 months?
Recommendation --> Resume routine screening.
Recommendation --> Colposcopy.
Negative
Positive
<-- What is the HPV testing result?
Recommendation --> Resume routine screening.
Recommendation --> Colposcopy.
No
Yes
<-- Currently pregnant?
Recommendation --> Either Colposocopy now (preferred) or Colposcopy deferred until at least 6 weeks postpartum (acceptable) may be performed.
Unknown
Negative
Positive
<-- What is the HPV result?
Recommendation --> Colposcopy.
Recommendation --> Either Co-Testing at 1 year (preferred) or Colposocopy (acceptable) may be performed.
Co-Testing at 1 year
Colposcopy
<-- Which follow-up study is chosen?
Recommendation --> Manage colposcopy per current ASCCP guidelines.
Cytology Negative and HPV Negative
HPV Positive or Cytology Abnormal - ASC-US, LSIL, ASC-H, AGC, HSIL
<-- Co-Test Result
Recommendation --> Repeat Co-Testing at 3 years.
Recommendation --> Colposcopy.
Recommendation --> Colposcopy.
Recommendation --> Repeat Cytology at 12 months is recommended. See
Women age 21-24 with ASC-US
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.
Recommendation --> Colposcopy.
Recommendation --> Colposcopy.
Recommendation --> Colposcopy.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.
Recommendation --> Colposcopy.
Recommendation --> Either Immediate Loop Electrosurgical Excision or Colposcopy with Endocervical Assessment may be performed.
Recommendation --> Colposcopy.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.
Endocervical
Endometrial
Not Otherwise Specified - NOS
Favor Neoplasia
Adenocarcinoma In Situ - AIS
Adenocarcinoma
<-- What is the subcategory?
Recommendation --> Endometrial and endocervical sampling.
No
Yes
<-- Is there an irregular bleeding pattern, unexplained vaginal bleeding, conditions suggesting chronic anovulation, or other risks for endometrial neoplasia?
Recommendation --> Colposcopy with endocervical sampling and endometrial sampling.
Recommendation --> Colposcopy with endocervical sampling and endometrial sampling.
Recommendation --> Colposcopy with endocervical sampling.
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.
References (Hide/Show)
Saslow D et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175-204.
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