MKSAP: 26-year-old woman is evaluated during a routine examination

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 26-year-old woman is evaluated during a routine examination. Her last Pap smear was performed 1 year ago and was normal. She has received a complete human papillomavirus (HPV) quadrivalent vaccine series. Medical history is unremarkable. Family history is noncontributory. She takes no medications.

On physical examination, temperature is normal, blood pressure is 110/72 mm Hg, and pulse rate is 78/min. The remainder of the physical examination is normal.

Which of the following is the most appropriate management of this patient’s cervical cancer screening?

A: Obtain HPV testing in 2 years
B: Obtain Pap smear in 2 years
C: Obtain Pap smear and HPV testing now
D: Obtain Pap smear and HPV testing in 2 years

MKSAP Answer and Critique

The correct answer is B: Obtain Pap smear in 2 years.

This patient should receive a Pap smear in 2 years. According to the U.S. Preventive Services Task Force and the American Congress of Obstetricians and Gynecologists, women aged 21 to 65 years should be screened for cervical cancer every 3 years with cytology (Pap smear). Performing screening more frequently adds little benefit while significantly increasing harms. Harms can include evaluation and treatment of transient lesions as well as false-positive screening results, which may lead to unnecessary colposcopies and emotional distress. Screening for cervical cancer is not recommended in women younger than 21 years, women age 65 years and older who are not at high risk and have had adequate prior Pap smears, and women who have had a hysterectomy with removal of the cervix with no previous history of a precancerous lesion. This patient had a normal Pap smear 1 year ago; therefore, she will be due for her next Pap smear in 2 years.

Owing to poor specificity, screening with human papillomavirus (HPV) DNA testing alone is not recommended. HPV testing is not recommended in women younger than 30 years, as HPV is not only highly prevalent but is also more likely to resolve without treatment in this age group. In women aged 30 to 65 years who want to lengthen the screening interval, a combination of cytology and HPV testing can be performed every 5 years. Women should be informed that there is an increased likelihood of receiving a positive screening result with HPV testing and cytology than with cytology alone. A positive HPV test result likely requires additional immediate testing and also involves more frequent surveillance.

All females aged 11 to 26 years should be vaccinated against HPV. HPV vaccination status does not alter recommendations for cervical cancer screening.

Key Point

  • Women aged 21 to 65 years should be screened for cervical cancer every 3 years with cytology (Pap smear); in women aged 30 to 65 years who want to lengthen the screening interval, a combination of cytology and human papillomavirus testing can be performed every 5 years.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

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