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Cervical cancer screening recommendations for immunocompromised patients without HIV

Cervical cancer screening recommendations for immunocompromised patients without HIV
Risk group category Recommendation
Solid organ transplant
  • Cytology is recommended if younger than 30 years.
  • Co-testing is preferred, but cytology is acceptable if 30 years or older.
  • If using cytology alone, perform annual cervical cytology. If results of 3 consecutive cytology results are normal, perform cytology every 3 years.
  • If using co-testing, perform baseline co-test with cytology and HPV. If result of cytology is normal and HPV is negative, co-testing can be performed every 3 years.
  • Continue screening throughout lifetime (older than 65 years). Discontinue screening based on shared discussion regarding quality and duration of life rather than age.
  • Screen patients on dialysis and posttransplant similarly.
Allogeneic hematopoietic stem cell transplant
  • Cytology is recommended if younger than 30 years.
  • Co-testing is preferred, but cytology is acceptable if 30 years or older.
  • If using cytology alone, perform annual cervical cytology. If results of 3 consecutive cytology results are normal, perform cytology every 3 years.
  • If using co-testing, perform baseline co-test with cytology and HPV. If result of cytology is normal and HPV is negative, co-testing can be performed every 3 years.
  • Continue screening throughout lifetime (older than 65 years). Discontinue screening based on shared discussion regarding quality and duration of life rather than age.
  • For HSCT patients who develop a new diagnosis of genital GVHD or chronic GVHD, resume annual cervical cytology until 3 consecutive normal results at which time perform cytology every 3 years, or perform an initial baseline co-test and, if cytology is normal and HPV is negative, perform co-testing every 3 years.
Inflammatory bowel disease on immunosuppressant treatments
  • Cytology is recommended if younger than 30 years.
  • Co-testing is preferred, but cytology is acceptable if 30 years or older.
  • If using cytology alone, perform annual cervical cytology. If results of 3 consecutive cytology results are normal, perform cytology every 3 years.
  • If using co-testing, perform baseline co-test with cytology and HPV. If result of cytology is normal and HPV is negative, co-testing can be performed every 3 years.
  • Continue screening throughout lifetime (older than 65 years). Discontinue screening based on shared discussion regarding quality and duration of life rather than age.
Inflammatory bowel disease not on immunosuppressant treatments
  • Follow general population screening guidelines.
Systemic lupus erythematosus and rheumatoid arthritis on immunosuppressant treatments
  • Cytology is recommended if younger than 30 years.
  • Co-testing is preferred, but cytology is acceptable if 30 years or older.
  • If using cytology alone, perform annual cervical cytology. If results of 3 consecutive cytology results are normal, perform cytology every 3 years.
  • If using co-testing, perform baseline co-test with cytology and HPV. If result of cytology is normal and HPV is negative, co-testing can be performed every 3 years.
  • Continue screening throughout lifetime (older than 65 years). Discontinue screening based on shared discussion regarding quality and duration of life rather than age.
Rheumatoid arthritis not on immunosuppressive treatments
  • Follow general population screening guidelines.
Type 1 diabetes mellitus
  • Follow general population screening guidelines.
Cervical cancer screening for patients with immunosuppression is initiated no sooner than 21 years of age. This is similar to patients without immunosuppression and discussed in related UpToDate content.
HPV: human papillomavirus; HSCT: hematopoietic stem cell transplantation; GVHD: graft versus host disease.
Table adapted from: Moscicki AB, Flowers L, Huchko M, et al. Guidelines for cervical cancer screening in immunosuppressed women without HIV infection. J Low Genital Tract Dis 2019; 23:87. DOI: 10.1097/LGT.0000000000000468. Copyright © 2019 ASCCP. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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