431
Cervical Lesions
and Cancer
Chapter 43
Janos L. Tanyi, MD, PhD
❍ When the Pap smear examinations should be initiated?
The American College of Obstetricians and Gynecologists (ACOG) revised their recommended cervical cancer
screening schedule for women in 2009. The new recommendation is that all women should have their first Pap smear
at age 21.
❍ What is the recommended schedule of Pap smears?
In 2009, the ACOG revised their recommended cervical cancer screening schedule for women. They recommend
start at age 21. Women in their 20s should have a Pap smear every 2 years (revised from previous recommendations
that it should be done annually). Women in their 30s who have had three consecutive normal Pap smears should
undergo one screening every 3 years. Women 65 to 70 who have had three consecutive normal Pap smear results
and no abnormal findings in the previous 10 years can discontinue screenings altogether if they choose. Women
who have undergone a total hysterectomy due to a noncancerous condition and have not had previously abnormal
Pap smears can also discontinue screenings.
❍ How frequently should a Pap smear be performed on an HIV-infected woman?
Women infected with HIV should have cervical cytology screening twice in the first year after diagnosis and
annually thereafter
❍ How frequently should a Pap smear be performed in a woman with history of CIN 2–3?
Women treated in the past for CIN 2, CIN 3, or cancer remain at risk of persistent or recurrent disease for at least
20 years after treatment and after initial post treatment surveillance and should continue to have annual screening
for at least 20 years.
❍ Is human papillomavirus (HPV) transmitted through vaginal intercourse alone?
No. HPV can be acquired through same-sex and nonpenetrative sexual contact.