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Cervical Cancer Screening

Sawaya, George F. MD; Smith-McCune, Karen MD, PhD

doi: 10.1097/AOG.0000000000001136
Contents: Cancer: Clinical Expert Series
Expert Discussion
Spanish Translation

Recent changes in cervical cancer screening and management guidelines reflect our evolving knowledge about cervical carcinogenesis. In the pursuit of precision, however, decision-making has become complicated. We provide an overview of cervical cancer screening with a focus on what clinicians can do to maximize screening benefits while minimizing screening harms. The approach relies on categorizing women at each step in the screening process by their estimated risk of high-grade precancerous lesions and cervical cancer. Current screening guidelines are designed to find a reasonable balance between benefits and harms by recommending less screening in most women. Current management guidelines are designed to assure consistent decisions regarding referral to colposcopy. After initial colposcopy, we outline three major management options based on risk assessment. For treatment, we recommend ablational procedures when appropriate because they are similarly effective, less costly, and potentially safer than excisional procedures. We advise caution in adopting new screening strategies until they demonstrate cost-effective patient-centered improvements compared with current strategies. Clinicians can maximize their effect on cervical cancer prevention by being attentive to guidelines, assuring that women have access to appropriate human papillomavirus vaccination and providing low-cost, high-quality screening and treatment.

To maximize benefits and minimize harms of cervical cancer screening, risk assessment of individual women at each step in the process is advised.

Department of Obstetrics, Gynecology and Reproductive Sciences, the UCSF Center for Healthcare Value, and the UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.

Corresponding author: George F. Sawaya, MD, University of California, San Francisco, 550 16th Street, Floor 7, Box 0132, San Francisco, CA 94143; e-mail:

Financial Disclosure Dr. Sawaya is a principal investigator of a National Cancer Institute-funded study (R01CA 169093) related to comparative effectiveness of cervical cancer screening strategies. Dr. Smith-McCune is a co-investigator on that study.

Continuing medical education for this article is available at

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.