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Table 1 Twenty-seven screening test strategies that differ by age of first screening, type of screening test and frequency of screening.

From: Human papillomavirus testing with Pap triage for cervical cancer prevention in Canada: a cost-effectiveness analysis

Test or test combination Strategy Frequency (years) Age when screening strategy begins
    18 years 25 years 18-24 via Miller1, 25+ via strategy
Pap only Pap1 1 (age 18 to 20) and 3 (age 21+) X (Screening Strategy (SS) 1)   
  Pap 1 X (SS 2)   
  Pap 2 X (SS 3)   
HPV testing only2 HPV 3 X (SS 4) X (SS 5) X (SS 6)
  HPV 5 X (SS 7) X (SS 9) X (SS 9)
Co-testing3 Pap + HPV 2 X (SS 10) X (SS 11) X (SS 12)
  Pap + HPV 3 X (SS 13) X (SS 14) X (SS 15)
  Pap + HPV 5 X (SS 16) X (SS 17) X (SS 18)
Triage (Pap followed by HPV)4 Pap with HPV triage 1 X (SS 19) X (SS 20) X (SS 21)
Triage (HPV followed by Pap)5 HPV with Pap triage 3 X (SS 22) X (SS 23) X (SS 24)
  HPV with Pap triage 5 X (SS 25) X (SS 26) X (SS 27)
  1. 1 This is the current recommendation for screening in Canada[20] Women are screened annually from age 18 to 20, and then every three years (for age 21+). Women who have an ≥ LSIL test result are referred for colposcopy and biopsy. Women with an ASC-US Pap result have a repeat Pap test and are referred to colposcopy and biopsy if their test result shows ≥ ASC-US. Women with a normal Pap test result return to routine screening. This strategy is referred to as the Miller strategy.
  2. 2 Women who are HPV+ (using a 1 RLU cutpoint) are referred directly for colposcopy and biopsy. Women who are HPV- return to routine screening.
  3. 3 Women who are HPV+ or who have an ≥ ASC-US Pap result are referred directly for colposcopy and biopsy. Women who are HPV- and have a normal Pap test result return to routine screening.
  4. 4 Women with an ≥ ASC-US Pap result are assumed to have an HPV test. Women who are HPV+ are referred for colposcopy. Women who have discordant results receive repeat testing with an HPV test and are referred to colposcopy if they are HPV+. Women who have an initial or subsequent normal test result are assumed to return to routine screening.
  5. 5 Women who are HPV+ are assumed to have a Pap test. Women with an ≥ ASC-US Pap result are referred for colposcopy. Women with discordant test results are assumed to receive another HPV test and are referred to colposcopy if they are HPV+. Women with an initial or subsequent normal test result are assumed to return to routine screening.