Patient handout

Cervical cancer screening (adult)

PRODUCTION

1. Your condition

This handout is for cervical cancer screening (adult). Your care team identified this based on: routine preventive/wellness visit — age-appropriate cervical screening due (uspstf 2018 grade a pmid 30140884).

Other reasons your team may use this plan: overdue or never-screened person with a cervix identified at any encounter — equity recall (self-collection option; arbyn bmj 2018 pmid 30518635); follow-up of a prior abnormal cytology/hrhpv/genotype result — apply asccp 2019 risk-table reasoning (perkins pmid 32243307); post-treatment cin2/3 surveillance entry — 25-year elevated-risk tail, not routine interval (asccp 2019 pmid 32243307).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cervical_cytology_q3yr_age_21_29	Cytology q3y, age 21-29	procedure	q3yr	USPSTF 2018 Grade A (PMID 30140884). Single-test cytology sens for CIN2/3 ~55.4% (Mayrand NEJM 2007 PMID 17942871) but the q3y program substantially reduces incidence + mortality (deaths 2.8→2.3 / 100k women 2000-2015). hrHPV NOT used <30 — transient-infection prevalence makes its PPV too low.
acs_start_age_25_cytology_acceptable	ACS 2020: start age 25 (cytology acceptable & transitional)	procedure	q3yr	ACS 2020 (Fontham CA Cancer J Clin 2020 PMID 32729638) starts at 25 vs USPSTF-2018 start 21; cytology acceptable until primary-HPV access universal.

Plan: Cervical 21-29 — cytology q3y (USPSTF 2018 Grade A PMID 30140884)

3. When to call your provider

Contact your care team if any of the following happen:

ASCCP immediate CIN3+ risk ≥4% → colposcopy/biopsy referral (Perkins PMID 32243307)
HPV-16/18+ with HSIL (immediate CIN3+ risk ≥60%) → expedited treatment / gyn-onc (ASCCP 2019)
CIN3+/AIS/invasive on histology → gynecologic oncology (differential-as-data — no terminal engine on disk)
Visible lesion / abnormal bleeding → diagnostic work-up, NOT screening (USPSTF 2018 scope)
Symptomatic cervicitis/PID look-alike → gyn.pelvic-inflammatory-disease.core.v1

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

ASCCP risk %: immediate CIN3+ risk ≥4% → colposcopy/biopsy; immediate ≥60% (e.g., HPV-16+ HSIL) → expedited treatment; 5-y CIN3+ risk <0.15% → 5-y return to routine; ~0.15-3.9% → 1-3 yr surveillance. The structured risk % is the post-test probability that crosses the workup/treat threshold (Perkins PMID 32243307; Egemen PMID 32243308)
A visible cervical lesion or abnormal/post-coital bleeding is a DIAGNOSTIC indication — exit average-risk screening to diagnostic colposcopy/work-up; symptomatic cervicitis/PID is a gyn look-alike, route to gyn.pelvic-inflammatory-disease.core.v1

5. Follow-up

STOP-screening / over-screening-harm logic (the deprescribing-equivalent): discontinue at >65 with adequate prior negatives (≥3 consecutive negative cytology OR ≥2 negative hrHPV/co-test in 10 y, most recent within 5 y) and no CIN2+ in 25 y; discontinue after total hysterectomy for benign indication with no CIN2+ history (USPSTF 2018 Grade D PMID 30140884). Patient education: over-screening harms (colposcopy/biopsy of regressive CIN, overtreatment), the value of NOT screening <21 / >65 / post-benign-hysterectomy, and that HPV vaccination does not change the interval (transitional — ACS 2020)

6. Sources

Guideline: USPSTF 2018 cervical cancer screening (FINAL, binding floor) + ASCCP 2019 risk-based management + ACS 2020 (start-25, hrHPV-primary preferred); USPSTF Dec-2024 DRAFT (primary-HPV-preferred-30 + self-collection) annotated as emerging, NOT yet final