Podcast Summary: The OB/GYN Resident Survival Guide

Episode #24: Cervical Cancer Screening Guidelines – Who to Screen, When to Screen, and How
Host: Dr. KC Miller
Air Date: March 30, 2026

Episode Overview

This episode delivers a comprehensive, high-yield review of current cervical cancer screening guidelines for average-risk patients, aligned with recommendations from ACOG, SGO, ASCCP, and the USPSTF. Dr. KC Miller breaks down when to start and stop screening, which tests are appropriate for different age groups, and key exceptions to the standard protocols—providing clear clinical pearls and actionable knowledge for OB/GYN residents and medical students.

Key Discussion Points & Insights

1. Unified Guidelines and Scope

• The guidelines discussed are endorsed by "the American College of Obstetricians and Gynecologists, the Society of Gynecologic Oncology, the American Society for Colposcopy and Cervical Pathology, and the United States Preventive Services Task Force” [03:26].
• Scope: Applies to average-risk patients; excludes those immunocompromised, with DES exposure, or a history of high-grade cervical disease.

2. When to Start Screening

• "Screening should start no earlier than the age of 21" [04:03].
• While there is potential for future changes as HPV vaccination rates increase, current guidelines maintain age 21 as the starting point due to suboptimal vaccination rates.
• "Remember, the HPV vaccine was only introduced in the United States in the year 2006, so we’re still building up the number of individuals that are vaccinated in this country." [04:31]

3. When to Stop Screening

• Discontinue after age 65 if patient has had adequate prior screening with negative results.
• Definition of “Adequate Prior Screening”:
  • “Three consecutive negative cytology results OR two consecutive negative co-testing results OR two consecutive negative high risk HPV primary test results, all within 10 years before screening is stopped.” [04:50]

4. How to Screen: Age-Based Recommendations

Ages 21–29

• Primary Method: “Screen with cytology only, no HPV, every three years.” [05:09]
• However, “the newer FDA-approved primary high risk HPV screening tests are acceptable for use starting at the age of 25, every five years.” [05:22]
• “If a patient wants to transition from cytology based testing to the high risk HPV primary testing at 25, this is supported by ACOG, ASCCP, and SGO.” [05:27]

Notable Quote:

• “The more we’ve learned about cervical cancer and pre-cancer, the more we’ve come to understand that the presence or absence of high risk HPV strains in a patient tells us a lot more about their cervical cancer risk than cytology does.” [05:40]

Ages 30–65

• Three Options:
  1. Primary high risk HPV testing (preferred): Every five years (“This is actually the preferred gold standard method per the Society of Gynecologic Oncologists.” [06:06])
  2. Cytology alone: Every three years
  3. Co-testing (cytology + HPV): Every five years

5. When NOT to Stop Screening (Exceptions)

• Case 1: History of Treated High Grade Lesions

  • E.g., CIN2, CIN3, AIS, HSIL, or persistent ASC-H.
  • “Screening needs to continue at three year intervals for at least 25 years after treatment, even if that period extends beyond the age of 65.” [06:50]

• Case 2: Never/Adequately Screened

  • “Screening shouldn’t be skipped simply because they are greater than the age of 65.”
  • “About 20% of cervical cancers occur in patients older than the age of 65.” [07:19]

• Case 3: Immunocompromised Patients (including HIV)

  • Screening should be lifelong, regardless of age [07:39].

• Case 4: Hysterectomy with History of CIN2 or Greater within Last 25 Years

  • “Continue with surveillance every three years for 25 years—even if that extends beyond the age of 65.” [07:53]

Notable Quotes & Memorable Moments

• Quote on high risk HPV as the future of screening:
  “It is possible that one day screening with cytology will just be cast to the wayside, but we’re not quite there yet.” [05:48]

• Pearl on the significance of screening after age 65:
  “About 20% of cervical cancers occur in patients older than the age of 65.” [07:19]

Important Segment Timestamps

• Introduction and congrats to match recipients: [00:00–02:10]
• Guideline overview and which patients guidelines apply to: [03:10–03:59]
• When to start screening: [04:00–04:30]
• When to stop screening & criteria for adequate prior screening: [04:31–05:09]
• Screening modalities by age: [05:09–06:36]
• Exceptions to stopping at 65 (who continues screening): [06:37–08:00]
• Rapid summary and wrap-up: [08:00–09:12]

Summary Table: Average Risk Patients

| Age Range | Screening Test Option(s) | Interval | |------------|-----------------------------------------------------------|-------------------| | 21–29 | Cytology only (Pap smear) | Every 3 years | | 25–29 | Optional: Primary high risk HPV testing | Every 5 years | | 30–65 | 1. Primary high risk HPV testing (preferred) | Every 5 years | | | 2. Cytology + HPV co-testing | Every 5 years | | | 3. Cytology alone | Every 3 years |

Note: Stop screening at 65 only if negative prior screens per criteria.

Residency Clinical Pearls

• “For the average risk patient, cervical cancer screening should begin at age 21 and stop at age 65, so long as they have had adequate prior screening with negative results. Specifically within the past 10 years…” [08:06]
• Key patient groups requiring further screening include those with:
  • Incomplete screening history
  • High-grade previous lesions
  • Immunocompromise
  • Relevant history post-hysterectomy

Final Notes

• All references, free resource downloads, and videos mentioned are linked in the show notes.
• Dr. Miller frequently repeats her openness to supporting listeners with questions about residency or matching.

For further resources and clinical tools, visit drkcmiller.com.