Table 1.
Twenty-seven screening test strategies that differ by age of first screening, type of screening test and frequency of screening.
| Test or test combination | Strategy | Frequency (years) | Age when screening strategy begins | ||
|---|---|---|---|---|---|
| 18 years | 25 years | 18-24 via Miller1, 25+ via strategy | |||
| Pap only | Pap1 | 1 (age 18 to 20) and 3 (age 21+) | X (Screening Strategy (SS) 1) | ||
| Pap | 1 | X (SS 2) | |||
| Pap | 2 | X (SS 3) | |||
| HPV testing only2 | HPV | 3 | X (SS 4) | X (SS 5) | X (SS 6) |
| HPV | 5 | X (SS 7) | X (SS 9) | X (SS 9) | |
| Co-testing3 | Pap + HPV | 2 | X (SS 10) | X (SS 11) | X (SS 12) |
| Pap + HPV | 3 | X (SS 13) | X (SS 14) | X (SS 15) | |
| Pap + HPV | 5 | X (SS 16) | X (SS 17) | X (SS 18) | |
| Triage (Pap followed by HPV)4 | Pap with HPV triage | 1 | X (SS 19) | X (SS 20) | X (SS 21) |
| Triage (HPV followed by Pap)5 | HPV with Pap triage | 3 | X (SS 22) | X (SS 23) | X (SS 24) |
| HPV with Pap triage | 5 | X (SS 25) | X (SS 26) | X (SS 27) | |
1 This is the current recommendation for screening in Canada[20] Women are screened annually from age 18 to 20, and then every three years (for age 21+). Women who have an ≥ LSIL test result are referred for colposcopy and biopsy. Women with an ASC-US Pap result have a repeat Pap test and are referred to colposcopy and biopsy if their test result shows ≥ ASC-US. Women with a normal Pap test result return to routine screening. This strategy is referred to as the Miller strategy.
2 Women who are HPV+ (using a 1 RLU cutpoint) are referred directly for colposcopy and biopsy. Women who are HPV- return to routine screening.
3 Women who are HPV+ or who have an ≥ ASC-US Pap result are referred directly for colposcopy and biopsy. Women who are HPV- and have a normal Pap test result return to routine screening.
4 Women with an ≥ ASC-US Pap result are assumed to have an HPV test. Women who are HPV+ are referred for colposcopy. Women who have discordant results receive repeat testing with an HPV test and are referred to colposcopy if they are HPV+. Women who have an initial or subsequent normal test result are assumed to return to routine screening.
5 Women who are HPV+ are assumed to have a Pap test. Women with an ≥ ASC-US Pap result are referred for colposcopy. Women with discordant test results are assumed to receive another HPV test and are referred to colposcopy if they are HPV+. Women with an initial or subsequent normal test result are assumed to return to routine screening.