A 66-year-old woman comes to the clinic for a routine follow-up visit. The patient immigrated to the United States from Haiti 6 years ago. Medical history includes osteoarthritis of the knees, lumbar spinal stenosis, and hypertension. At age 45, she underwent a supracervical hysterectomy, leaving an intact cervix. Her last mammogram, performed several months ago, was normal. The patient is up to date with colonoscopy screening. She received influenza and pneumonia vaccines last year. Her last two Pap tests with human papillomavirus (HPV) cotesting were normal 1 and 6 years ago. The patient's only other Pap test, which was normal, was performed just before the hysterectomy. She had a new sexual partner since her last visit.
Vital signs and physical examination are within normal limits.
Which of the following is the best next step for cervical cancer screening in this patient?

Question

A 66-year-old woman comes to the clinic for a routine follow-up visit.  The patient immigrated to the United States from Haiti 6 years ago.  Medical history includes osteoarthritis of the knees, lumbar spinal stenosis, and hypertension.  At age 45, she underwent a supracervical hysterectomy, leaving an intact cervix.  Her last mammogram, performed several months ago, was normal.  The patient is up to date with colonoscopy screening.  She received influenza and pneumonia vaccines last year.  Her last two Pap tests with human papillomavirus (HPV) cotesting were normal 1 and 6 years ago.  The patient's only other Pap test, which was normal, was performed just before the hysterectomy.  She had a new sexual partner since her last visit.
Vital signs and physical examination are within normal limits.
Which of the following is the best next step for cervical cancer screening in this patient?

Quizplus · Accepted Answer

11ec193a_97e1_fc99_853d_c7faa90a2e46_MD0002_00 Current recommendations for cervical cancer screening include Pap testing alone every 3 years at age 21-29. In women age 30-65, screening is with Pap testing alone every 3 years, Pap test plus human papillomavirus (HPV) cotesting every 5 years, or primary HPV testing alone every 5 years. Cervical cancer screening can be discontinued in patients age ≥65 with: Low risk of cervical cancer No history of high-grade squamous intraepithelial lesions No tobacco use or sexually transmitted infection, and without multiple sexual partners or immunosuppression Low risk of cervical cancer No history of high-grade squamous intraepithelial lesions No tobacco use or sexually transmitted infection, and without multiple sexual partners or immunosuppression Low risk of cervical cancer No history of high-grade squamous intraepithelial lesions No tobacco use or sexually transmitted infection, and without multiple sexual partners or immunosuppression No history of high-grade squamous intraepithelial lesions No history of high-grade squamous intraepithelial lesions No tobacco use or sexually transmitted infection, and without multiple sexual partners or immunosuppression No tobacco use or sexually transmitted infection, and without multiple sexual partners or immunosuppression Prior adequate screening 3 consecutive negative Pap tests within the past 10 years, the most recent within the past 5 years2 consecutive negative HPV tests within the past 10 years, the most recent within the past 5 years Prior adequate screening 3 consecutive negative Pap tests within the past 10 years, the most recent within the past 5 years2 consecutive negative HPV tests within the past 10 years, the most recent within the past 5 years Prior adequate screening 3 consecutive negative Pap tests within the past 10 years, the most recent within the past 5 years2 consecutive negative HPV tests within the past 10 years, the most recent within the past 5 years 3 consecutive negative Pap tests within the past 10 years, the most recent within the past 5 years 3 consecutive negative Pap tests within the past 10 years, the most recent within the past 5 years 2 consecutive negative HPV tests within the past 10 years, the most recent within the past 5 years 2 consecutive negative HPV tests within the past 10 years, the most recent within the past 5 years Women who underwent a supracervical hysterectomy (ie, intact cervix) and those with an intact uterus have a similar cervical cancer risk. This patient underwent a supracervical hysterectomy and had adequate prior screening (2 consecutive negative HPV tests within the past 10 years) and therefore does not require further cervical cancer screening. (Choice A) Cervical cancer screening with HPV testing alone (primary HPV testing) every 3 years is an alternate screening to cotesting and Pap testing alone. Primary HPV testing can also be discontinued at age >65. (Choices C, D, and E) A new sexual partner is not an indication for continuing cervical cancer screening in patients age >65. Educational objective: Current cervical cancer screening guidelines include Pap testing alone every 3 years at age 21-29. In women age 30-65, screening is with Pap testing alone every 3 years, Pap test plus human papillomavirus (HPV) cotesting every 5 years, or primary HPV testing alone every 5 years. Screening can be discontinued in low-risk women age ≥65 with prior adequate screening. __________ References: Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/22711081)

A 66-Year-Old Woman Comes to the Clinic for a Routine