Screening for cervical cancer and initial treatment of patients with abnormal results from papanicolaou testing

New techniques for cervical cancer screening and a better understanding of the natural history of human papillomavirus (HPV) and cervical neoplasia have inspired a quest for more rational screening strategies for cervical cancer. Often, screening intervals for women older than 30 years can be expanded safely to every 3 years, and experts now agree that screening may cease after hysterectomy and in elderly women (provided certain criteria have been met). Liquid-based cytology produces more satisfactory specimens than conventional testing and offers the valuable option of treating atypical squamous cells of undetermined significance by "reflex" testing for high-risk types of HPV on the original specimen. Testing for HPV as an adjunct to cervical cytology for primary screening is now considered reasonable for many women older than 30 years.