http://caonline.amcancersoc.org/cgi/content/full/52/6/342
CA Cancer J Clin 2002; 52:342-362
© 2002 American Cancer Society
American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer
A summary from the NCI website
Cervical cancer screening should begin approximately three years after a woman begins having sexual intercourse, but no later than at 21 years old.
Experts recommend waiting approximately three years following the initiation of sexual activity because transient HPV infections and cervical cell changes that are not significant are common and it takes years for a significant abnormality or cancer to develop. Cervical cancer is extremely rare in women under the age of 25.
Women should have a Pap test at least once every three years.
Women 65 to 70 years of age who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, upon consultation with their healthcare provider, to stop cervical cancer screening.
Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.
Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.
And here is a the paragraph on when to start
(emphasis added)
When to Start Screening
Recommendation
Cervical cancer screening should begin approximately three years after the onset of vaginal intercourse. Screening should begin no later than 21 years of age. It is critical that adolescents who may not need a cervical cytology test obtain appropriate preventive health care, including assessment of health risks, contraception, and prevention counseling, screening and treatment of sexually transmitted diseases. The need for cervical cancer screening should not be the basis for the onset of gynecologic care.
Rationale
The published and unpublished data on the incidence of cervical cancer and the natural history of HPV infection and of low- and high-grade cervical lesions suggest that there is little risk of missing an important cervical lesion until three to five years after initial exposure to HPV (Evidence section). Thus, cervical cytology screening in adolescents is unlikely to add appreciable benefits within the first three years following onset of vaginal intercourse.
It is the intent of the ACS that offering screening "approximately" three years after the onset of sexual intercourse will avoid denial of health insurance coverage for teens and young women who undergo their first cytology test prior to the suggested three years. However,
the concern is that screening before the three-year-period may result in an overdiagnosis of cervical lesions that will regress spontaneously, leading to inappropriate intervention which may result in more harm than good. Because the risk of HPV transmission to the cervix is low for other types of sexual activity, the onset of vaginal sexual intercourse has been selected as the historical marker for initiating cervical cytology screening.
An upper age limit for when to initiate screening is needed for providers who dont ask patients about their sexual history and for adolescents who are unable or unwilling to disclose prior consensual and/or noncon-sensual intercourse. Such an upper age limit ensures that young women, including victims of sexual abuse, are protected.
In cases where a history of sexual abuse has been established, there is a lack of evidence to support earlier cervical screening for victims of prepubescent sexual abuse. Abuse victims who have had vaginal intercourse, especially post-puberty, may be at increased risk of HPV infection and cervical lesions and should be referred for screening once they are psychologically and physically ready (i.e., post-puberty) by a provider who has experience and sensitivity for working with abused adolescents.
Provider discretion and patient choice following counseling should be used to guide the initiation of cervical cytology screening in young women aged 21 and older who have never had vaginal sexual intercourse and for whom the absence of a history of sexual abuse is certain.
Young women who are infected with HIV and/or are immunocompromised should follow the US Public Health System Guide-lines, i.e., obtain a Pap test twice in the first year after diagnosis of HIV infection and, if the results are normal, annually thereafter
CA Cancer J Clin 2002; 52:342-362
© 2002 American Cancer Society
