CHAPTER 4: SCREENING FOR CERVICAL CANCER

86Chapter 4: Screening for Cervical Cancer4Chapter 4: Screening for Cervical CancerRecommended target ages and frequency of cervicalcancer screening• New programmes should start by screening women aged 30 years or more,and include younger women only when the higher-risk group has been covered.Existing organized programmes should not include women less than 25 years ofage in their target populations.• If a woman can be screened only once in her lifetime, the best age is between 35and 45 years.• For women over 50 years, a five-year screening interval is appropriate.• In the age group 25–49 years, a three-year interval can be considered if resourcesare available.• Annual screening is not recommended at any age.• Screening is not necessary for women over 65 years, provided the last twoprevious smears were negative.Special considerationsBefore embarking on a widespread screening programme, national planners shouldensure that the services needed to manage newly identified cancer cases are in place.To treat invasive cancer effectively, specialized facilities are needed; these must be inplace before a screening programme is put into effect (see Chapter 6).If a population has not previously been screened, many cases of pre-existing cancer indifferent stages will be detected in a new screening programme. Women whose diseaseis very advanced, or for whom treatment is impossible for any reason, should receivepalliative care (see Chapter 7).Screening in settings with high HIV prevalenceIn settings with high HIV prevalence, screening for cervical cancer is particularlyimportant. HIV-positive women have more persistent HPV infections, and a higherincidence of cervical precancer and, in some settings, invasive cervical cancer. WhereHIV is endemic, screening results may be positive in up to 15–20% of the targetpopulation. Cytology screening is equally effective in HIV-positive and HIV-negativewomen. Although HIV-infected women are at greater risk of precancer and cancer,screening, follow-up and treatment may not be a priority for the women themselves,who have competing health or social needs. All women, regardless of their HIV status,