Which of the following patients would require a Pap test as part of a routine health maintenance examination?

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11ec193a_97e0_eb27_853d_25731750be10_MD0002_00 Cervical cancer is caused by persistent infection with high-risk strains (eg, type 16, 18) of human papillomavirus (HPV). Risk factors include early onset of sexual activity, multiple sex partners, tobacco use, and immunosuppression. Screening identifies patients with abnormal cytology/premalignancy and prevents progression to malignancy. Current screening guidelines include initiation of cervical cancer screening at age 21 irrespective of sexual activity (Choice A). In women age 21-29, screening is with Pap testing every 3 years. In women age 30-65, screening options include: Pap testing every 3 years ORPap and HPV cotesting every 5 years ORPrimary HPV testing every 5 years Pap testing every 3 years OR Pap and HPV cotesting every 5 years OR Primary HPV testing every 5 years Therefore, a patient age 30-65 who had a normal Pap test 3 years ago would need testing. In contrast, a patient who had a normal Pap and a negative HPV test 4 years ago would not (Choice B). Exceptions to these guidelines include patients who are HIV positive or immunosuppressed. These patients require screening at the time of diagnosis (HIV) or at the onset of sexual activity (immunosuppression) and require screening at more frequent intervals. (Choice D) Pap testing is not indicated in patients who have undergone a total hysterectomy (eg, with removal of the cervix) for benign conditions (eg, leiomyoma, pelvic pain) and who have no history of cervical intraepithelial neoplasia or cancer. (Choice E) Pap testing can be discontinued at age ≥65 in patients who have had adequate screening (eg, 3 negative Pap tests or 2 negative HPV tests in the last 10 years) and no previous high-grade squamous intraepithelial lesion. Educational objective: Current guidelines recommend initiating routine cervical cancer screening at age 21. Recommended screening strategies for women age 30-65 include Pap tests every 3 years, Pap plus human papillomavirus (HPV) cotesting every 5 years, and primary HPV testing every 5 years. Screening can be discontinued in most women age ≥65 or have had a total hysterectomy. __________ References: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. (http://www.ncbi.nlm.nih.gov/pubmed/22422631) Practice Bulletin No. 168: cervical cancer screening and prevention. (http://www.ncbi.nlm.nih.gov/pubmed/27661651)

Which of the Following Patients Would Require a Pap Test