New clinical management guidelines for cervical cytology screening advise that screening should begin at age 21, not at the age of first sexual intercourse. The guidelines, released in the American College of Obstetricians and Gynecologists' ACOG Practice Bulletin, say the change is "based on the potential for adverse effects associated with follow-up of young women." Initially, screening is recommended every 2 years. For women over 30 who have had three consecutive negative screenings, screening may occur at 3-year intervals. Women with certain risk factors may require more frequent screenings: those infected with HIV, the immunosuppressed, those with in utero exposure to DES, women with a history of cancer or cervical intraepithelial neoplasia. Screening can be discontinued for most women between 65 and 70, or who have had a hysterectomy for benign indications and no history of high-grade CIN. The guidelines also give recommendations on HPV screening. Both the New York Times and the Washington Post report that release of the cervical screening guidelines and those on mammography within the same week was a coincidence. Both recognized that the ACOG guidelines would add fuel to the political firestorm over health care reform.
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