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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.
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BMC Medicine

ISSN: 1741-7015

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