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GYN
CMECNE

Screening for Cervical Cancer in the Woman at Average Risk

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Contrast screening and cotesting frequency in women between age 21-29, 30-65 and over 65
2. Outline those women at increase risk of cervical cancer who need a higher level of surveillance

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS: 

In the case of an average woman who is being seen for cervical cancer screening:

  • Begin screening average risk women at age 21
    • Screen every 3 years with cytology, with reflex human papillomavirus (HPV) if the cytology results in an abnormal Pap smear result
    • Do not perform HPV testing routinely
  • Women age 30-65 can be screened
    • Every 5 years ‘cotesting’ with cytology plus HPV (preferred)
    • Every 3 years with cytology only (acceptable)
    • Primary screening with hrHPV testing alone can be considered as an alternative to the above
      • Expert interim guidance (2015): Re-screen no sooner than 3 years
      • USPSTF guidance (2018): Every 5 years
    • Changes in risk factors, including a new sexual partner may warrant more frequent screening
  • Stop screening average-risk women older than 65 for cervical cancer IF
    • They have had 3 consecutive negative cytology results or 2 negative cytology with negative HPV results within 10 years
    • AND the most recent Pap test was within 5 years
  • Do not screen average risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix (i.e. you can’t get cervical cancer without a cervix)

SYNOPSIS:

Cervical cancer rates in the United States are low, 7.8 cases per 100,000 women per year due largely to access to effective screening.  Cervical cancer is believed with a high degree of certainty, to be the delayed consequence of infection with high risk or oncogenic human papillomavirus (HPV).  The majority of HPV infections are transient and do not progress to cervical cancer.  The consequences of cervical treatment harms can be significant and excisional procedures (LEEP, cervical cone biopsy) may increase the risk of a subsequent preterm birth.

KEY POINTS:

  • The goal of cervical cancer screening is to minimize harm and maximize benefit
  • New guidelines focus on increasing the age at which to begin screening, lengthening the screening interval and discontinuing screening women at low risk for future cervical cancer
  • The above action items refer to average risk women
  • Women at increased risk for cervical cancer require a higher level of surveillance and include those who are:
    • Immunocompromised (HIV positive, organ transplant recipient, chronic steroid use)
    • Sex workers
    • Women with multiple partners or high risk partners
    • Women with a history of abnormal Pap smear  or precancerous genital conditions
    • Smokers
    • Women with a history of sexually transmitted diseases
  • American Cancer Society (2020) has recommended the use of HPV testing in isolation
    • 25 to 65 years of age: ‘Primary’ HPV testing every 5 years
    • If HPV testing is not available, other acceptable screening methods: HPV and cervical cytology every 5 years or cervical cytology alone every 3 years
    • Women >65: Stop screening if patient meets the following criteria
      Regular screening in the past 10 years with normal results and no history of CIN2 or higher in the past 25 years
    • Total hysterectomy: Stop screening (unless surgery was for cervical cancer or pre-cancer)
    • Supra-cervical hysterectomy: Continue screening
    • Patients who have had HPV vaccine: Continue to screen based on guidelines
  • Diagnosis Codes:
    • Z01.411 encounter for routine gyn exam with abnormal findings
    • Z01.412 encounter for routine gyn exam with normal findings
    • Z01.42 encounter for exam to confirm normal smear after history of abnormal cervical cytology

Learn More – Primary Sources:

ACOG Practice Bulletin 168: Cervical Cancer Screening and Prevention

Cancer Screening in Average-Risk Women: Best Practice Advice from the Clinical Guidelines Committee of the American College of Physicians

ASCCP Management Guidelines and Algorithms

USPSTF (2018): Cervical Cancer Screening

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Locate a GYN Oncology Specialist:

Gyn Oncology Locator – SGO

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Related ObG Topics:

Cervical Cancer Screening Guidelines – Including ‘HPV Only’ Option
ACOG, AAFP & USPSTF Guidance: Still a Role for the Annual Pelvic Exam?
Colposcopy Results: Follow-Up and Management
Practical info for your gynecology practice

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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