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Governments should take a health systems approach when initiating and scaling-up comprehensive cervical cancer prevention and control programmes to avoid establishing stand-alone, disease-specific initiatives and to ensure long-term sustainability. When planning prevention programmes, it is important to recognize that: (1) access to treatment of precancerous lesions is a necessary prerequisite for an effective cervical cancer screening programme; (2) screening and pre-cancer treatment should be part of a package of essential health services; (3) delivery of services should ideally be through primary health care services, or as close to the community-level as possible; and (4) there should be universal. | Screening for Cervical Cancer Recommendations and Rationale U.S. Preventive Services Task Force This statement summarizes the current U.S. Preventive Services Task Force USPSTF recommendations on screening for cervical cancer and the supporting scientific evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services Second Edition.1 Explanations of the ratings and of the strength of overall evidence are given in Appendix A and in Appendix B respectively. The complete information on which this statement is based including evidence tables and references is available in the Systematic Evidence Review Screening for Cervical Cancer 2 available through the USPSTF Web site http www.preventiveservices .ahrq.gov and through the National Guideline ClearinghouseTM http www.guideline.gov . The summary of the evidence and the recommendation statement are also available in print through the AHRQ Publications Clearinghouse call 1-800-3589295 or E-mail ahrqpubs@ahrq.gov . Summary of Recommendations The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. A recommendation. The USPSTF found good evidence from multiple observational studies that screening with cervical cytology Pap smears reduces incidence of and mortality from cervical cancer. Direct evidence to determine the optimal starting and stopping age and interval for screening is limited. Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 whichever comes first and screening at least every 3years see Clinical Considerations . The USPSTF concludes that the benefits of screening substantially outweigh potential harms. The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer see Clinical
