Summary4 min read

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.

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Transcript1 lines

[00:00]
A
Hello and welcome back for another episode of the OB GYN Resident Survival Guide, a podcast with bite sized clinical pearls that you can consume on the run. I'm Dr. Miller, a board certified OB GYN and your host for the show. Today I'm going to be reviewing cervical cancer screening, the who, the when and the how. Before I jump in, I want to wish a special congratulations to all of you listeners that matched to residency this past week. It's truly such an exciting time and I would love to know where you matched and into what specialty. I think most of you guys that applied this year were applying to OB GYN and or Family Medicine, but let me know. You can send me a message on Instagram or by email@infooctor caseymiller.com if you did match into OB GYN, don't forget to download the OB GYN residency starter package. It's a free five step guide for incoming interns that covers what sutra skills to practice, apps to download, what practice bulletins to review leading up to July 1st and more. The link to download that is in the Show Notes. I also want to give a special shout out to those of you that did not match this year. Please, please know that this is not the end of the road for you. You do have a place and future in medicine and I know that there are many, many excellent physicians and excellent physician content creators out there that themselves did not match the first or second time around that have made some very encouraging videos about that time in their lives. I will link at least one of those videos in the Show Notes for you to watch. And if you need a little bit of encouragement or some words of inspiration again, please feel free to reach out to me. I would love to connect all right, let's get into the cervical cancer screening. The guidelines I'm reviewing today are not only endorsed by the American College of Obstetricians and Gynecologists, but also the Society of Gynecologic Oncology, or sgo, the American Society for Colposcopy and Cervical Pathology, known as asccp, and the United States Preventative Services Task Force, or USPSTF for short. And it's one of the few cancers where screening recommendations are unified across multiple organizations. These recommendations are also specifically for average risk patients, those who are not immunocompromised, those who do not have a known history of high grade histology, those with no known in utero exposure to diethylstilbitrol or DES, etc. So first things first, when do we do cervical cancer screening Screening should start no earlier than the age of 21 and eventually if vaccination rates increase, this may get pushed out to the age of 25. But for now, while vaccination rates remain below target levels in the United States, we start at 21. 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. Cervical cancer screening can be discontinued after the age of 65 if they have had adequate prior screening with negative results and this is defined as 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. So how do we screen for patients age 21 to 29? We primarily screen with cytology only, no HPV and every three years. That being said, the newer FDA approved primary high risk HPV screening tests are acceptable for use starting at the age of 25 every five years. So 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 and SGO. 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. So it is possible that one day screening with cytology will just be cast to the wayside, but we're not quite there yet. For patients between the ages of 30 and 65, we have three screening options. The first is the one we just talked about, primary high risk HPV testing every five years. This is actually the preferred gold standard method per the Society of Gynecologic Oncologists. Alternatively, we can screen with cervical cytology alone every three years or with CO testing which is a combination of cytology and high risk HPV testing every five years. Let's review again when to stop screening. Earlier I mentioned that average risk patients with adequate prior screening with negative results can stop screening after the age of 65. I wanted to give some examples of when screening beyond the age of 65 is recommended. Example 1 includes any patient with a history of treated high grade histology or high grade cytology. So think CIN2, CIN3, AIs, HSIL or persistent Ask H. After the initial post treatment surveillance period, 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. Example number two includes patients who have never been adequately screened. So if you have a patient that comes to you to establish care and they're 68 years old, for example, and have never had a Pap smear or or they haven't had one in the last 10 years, screening shouldn't be skipped simply because they are greater than the age of 65. Remember, about 20% of cervical cancers occur in patients older than the age of 65. Example number three includes immunocompromised patients, including patients that have HIV. In these patients, screening should continue throughout their entire life, regardless of their age. Lastly, example number four includes patients who have had a hysterectomy, even if it was a total hysterectomy, meaning they have no cervix anymore with a history of CIN2 or greater within 25 years. These patients should also continue with surveillance every three years for 25 years, even if that extends beyond the age of 65. All right, that's it for today. Let's go ahead and summarize. 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 between the ages of 21 and 29. Screening should be done with cytology alone every three years, unless the patient elects to transition to primary high risk HPV testing at the age of 25, which can then be done every five years at and after the age of 30. Screening can be done three different ways, either with the FDA approved primary high risk HPV test every five years, or cytology and HPV co testing every five years, or cytology alone every three years. Examples of patients who should continue screening beyond the age of 65 include those with a history of treated high grade histology who have not yet completed 25 years of surveillance even if they've had a hysterectomy A as well as patients who have never been adequately screened and immunocompromised patients. Thanks so much for listening. Congrats again with the match. And as usual, all of the references and downloads and videos I discussed at the beginning of the episode are linked in the show notes. See you next week.