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The American College of Obstetricians and Gynecologists (ACOG, 2009) recommend that cervical cytology screening begin at age 21 regardless of age at onset of sexual activity and from age 21 to 29, testing is recommended every 2 years but should be more frequent in women who are HIV-positive, immunosuppressed, were exposed in- utero to diethylstilbestrol (DES), or have been treated for cervical intraepithelial neoplasia (CIN) grade 2, 3 or cervical cancer.The ACOG guidelines on cervical cancer in adolescents (2010) recommend that adolescents with HIV have cervical cytology screening twice in the first year after diagnosis and annually thereafter.
The American Cancer Society, National Cancer Institute, and American Medical Association recommend that cervical cytology screening should begin within 3 years of onset of sexual activity or age 21.
The recommendation allows less frequent Pap testing after 3 or more annual smears have been normal, at the discretion of the physician.
For women who have had repeated negative tests, the marginal gain from screening more often than every 3 years decreases sharply.
However, because of the difficulty in identifying patients at increased risk for cervical cancer, most physicians will recommend a Pap test be performed at least once-yearly.
The American College of Physicians (ACP) recommends Pap smears every 3 years for women aged 20 to 65, and every 2 years for women at high-risk.
The ACP also recommends screening women aged 66 to 75 every 3 years if not screened in the 10 years before age 66.
Currently there are no formal guidelines for anal Pap smear screening.
The Centers for Disease Control and Prevention (Workowski and Bolan, 2015) stated: "Data are insufficient to recommend routine anal-cancer screening with anal cytology in persons with HIV infection or HIV-negative MSM.
The cells are removed by brushing or scraping the cervix during a pelvic examination and then placing the cells on one or more glass slides.