Learning objectives
What is the objective of screening?
Why isn’t finding lesions the objective
Then why do we look for lesions?
Selecting optimal screening test
Reducing cervical cancer risk
What were the old standards?
The old standards worked
Annual cancer risk, US women
Current cervical cancer risk is low
Age-standardized cancer incidence
Residual risk of cervical cancer
More on residual risk
Why change?
Why change? cont.
If annual Pap testing works, why change?
Development of HPV DNA Positivity Chart
HPV cumulative incidence among women
Weighted prevalence of low-risk and high-risk HPV
What is the natural history of LSIL/CIN1 in adolescents?
Rapid clearance of HPV in Women >30
Projected Prevalence of HPV and CIN by Age
Natural history of LSIL/CIN1 in adolescents?
Similar high likelihood of clearance of newly acquired HPV
Why isn't more just better?
5y CIN3+ risk after neg cotest
More harms to screening
What are the 2011 standards?
Consensus Conference
ACS/ASCCP/ASCP guidelines I
ACS/ASCCP/ASCP guidelines II
ACS/ASCCP/ASCP guidelines IV
ACS/ASCCP/ASCP guidelines V
ACS/ASCCP/ASCP guidelines VI
Changes from 2002 guidelines
When to start screening
Rationale for later screening start
Others start screening later
When to start screening
Screening intervals
Rationale for longer intervals
Rationale for avoiding HPV tests
Screening intervals
Why prefer cotesting?
Why prefer cotesting? cont.
Why not cotesting?
Why not annual cotesting?
When to stop screening
When to stop screening cont.
Rationale for stopping at 65yo
Rationale for stopping after hyst
When to stop screening
When NOT to stop at 65yo
Impact of vaccination
HPV as a primary screen
Summary: the 2011 standards
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