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35-year-old woman
1%
1/134
60-year-old woman
17%
23/134
28-year-old woman who has been vaccinated against human papillomavirus
8%
11/134
19-year-old who is sexually active
64%
86/134
25-year-old homosexual
7%
10/134
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Women younger than 21 are no longer recommended to undergo screening for cervical cancer. The latest recommendations from the US Preventative Services Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP) recommend against screening women younger than 21 for cervical cancer, regardless of the age of sexual initiation or other risk factors. Note that the recommendations are regardless of the patient's sexual orientation or her partner's sexual orientation. Saslow et al. in the ACS/ASCCP/ASCP recommendations, state that women aged 21-29 should be screened with cytology alone every 3 years. Women aged 21-29 with 2 or more consecutive negative cytology results still need to be screened every 3 years; the evidence does not support a longer interval follow-up. Juckett et al. discuss human papillomaviruses (HPV). The most common sexually transmitted infection and nearly all cervical cancers caused by HPV. Not all infections are the same, as some strains are responsible for low risk infections, resulting in genital warts, while others are much higher risk because of their association with cervical intraepithelial neoplasia and malignancies. Illustration A depicts a normal Pap smear. Note the abundant cytoplasm shown by the arrow, and the pyknotic nuclei. Illustration B depicts an abnormal Pap smear. Note the large, basophilic nuclei, and high nuclear to cytoplasmic ratio. Incorrect Answers: Answer 1 and 2: Saslow et al. state, "Women aged 30 to 65 years should be screened with cytology and HPV testing (“cotesting”) every 5 years (preferred) or cytology alone every 3 years (acceptable). There is insufficient evidence to change screening intervals in this age group following a history of negative screens." Answer 3: Saslow et al. state, "Recommended screening practices should not change on the basis of HPV vaccination status." Answer 5: Recommendations for cervical cancer screening do not vary with sexual orientation.
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