Did you know that January is Cervical Health Awareness Month?

by Elyse Watkins, DHSc, DFAAPA

While you’re not likely to see an overwhelming number of t-shirts, scarves, and socks in teal and white (the color for Cervical Health Awareness Month), there are some interesting and important facts about cervical cancer screening that may be useful for your practice.

  • Over 99% of cervical cancers in the United States are caused by high risk HPV genotypes.
  • Over 90% of anal cancers are caused by HPV.
  • About 70% of oropharyngeal cancers in men and over 60% in women are caused by HPV.
  • In average risk women, it can take 10 – 20 years after an exposure to an oncogenic HPV genotype to undergo a malignant transformation.

Cervical dysplasia is different than cervical cancer. Most low grade cervical dysplasias are caused by non-oncogenic HPV genotypes and will regress spontaneously in women who are not immunocompromised. High grade dysplasias are caused by oncogenic HPV genotypes and should be managed more aggressively with minor surgical techniques, such as cold knife cone and loop electrosurgical excision procedures.

Cervical cancer incidence in the United States is decreasing, largely due to early diagnosis and intervention of dysplasia with Pap and colposcopy as well as vaccination against the HPV genotypes most closely associated with not just cervical dysplasia and cancer, but oropharyngeal and anal cancers.

The American Society for Colposcopy and Cervical Pathology (ASCCP) have published guidelines on Pap and HPV testing for women. You can find the guidelines here: http://www.asccp.org/asccp-guidelines. The United States Preventive Services Taskforce (USPSTF) published an updated clinical guideline on cervical cancer screening in August 2018 (https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Cervical-Cancer-Screening-Update). The USPSTF advises the following in average risk women:

  • Women <21 years: no screening is recommended.
  • Women 21 – 29 years: should not receive co-testing as a screen. Cytology with Pap is sufficient.
  • Women 30 – 65 years: cytology alone every 3 years, high risk HPV testing alone every 5 years, or high risk HPV with cytology every 5 years.

One of the important updates from the USPSTF is that high risk HPV testing alone, without a Pap, can be utilized in average risk women 30 – 65 years. Be careful when you are coding for your visits if you are only performing high risk HPV screening without a Pap test. The ICD-10 code for the Pap test is Z12.4 with a specific exclusion for HPV screening. The appropriate code for HPV screening without a Pap is Z11.51.

Perhaps most importantly, the Food and Drug Administration recently expanded the use of the 9-valent HPV vaccination (Gardasil-9®) for men and women up to age 45 years. The previous recommendation allowed men and women to receive the vaccination up until age 26 years.


See Elyse Watkins, DHSc, DFAAPA at the GAPA 2019 Summer Conference in Hilton Head Island, SC.

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