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Young women should delay their first Pap test for cervical cancer until their 21st birthday, and many others can wait longer for follow-up testing, according to new guidelines released on Nov. 20, 2009 by the American College of Obstetrics and Gynecologists (ACOG).
ACOG made new recommendations about the test used to screen for cervical cancer after determining more frequent testing did not catch significantly more cancer and often resulted in girls and young women experiencing unnecessarily stress and anxiety, and sometimes harmful treatments of suspicious growths that would not cause health problems.
Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico led the revision of the guidelines. Dr. Waxman said, more testing is not always more intelligent testing.
“The incidence of cervical cancer in 15-to 19-year-olds has been reported at 1 to 2 per million girls. That’s a lot of unnecessary pelvic exams and unnecessary potential treatments that can be avoided.”
The new screening recommendations comes amid pointed controversy over new guidelines from a federal task force that women wait until age 50 before they begin having routine mammograms and that women age 50 to 74 scale back to getting the exams routinely every two years.
The American Cancer Society, which has led the opposition to the mammography guidelines issued by the U.S. Preventive Services Task Force, was involved in the discussions leading up to the Pap test guidelines and will consider them in reevaluating its own recommendations, said Debbie Saslow, PhD, American Cancer Society, director of breast and gynecologic cancer.
Cervical cancer screening guidelines have evolved as scientists have gained a greater understanding of how the disease develops. Almost all cervical cancers are caused by the Human Papilloma Virus or HPV and most tend to develop slowly. Over the last 30 years, screening has decreased the cervical cancer incidence rate by half, according to ACOG, which could affect as many as 11,270 US women in 2009.
The newly modified ACOG guidelines, published in the December issue of Obstetrics & Gynecology, aren’t radically different from their previous 2002 recommendations for how often women should be screened for cervical cancer. Rather than recommending young women seek their first pap test three years after the onset of sexual activity as previously recommended, the new guidelines say age 21 is soon enough, regardless of when sexual activity began.
Women age 30 and older should be screened for cervical cancer once every two years, instead of annually as was previously recommended. ACOG also recommends women age 30 and older who have had three consecutive negative tests to be screened once every three years. However, the recommendations point out that certain women, including those with HIV or a weakened immune system, still get screened every year. The same goes for women who have had previous cervical abnormalities, and women exposed to the chemical DES, a manmade form of the female hormone estrogen prescribed from 1938 to 1971.
The new guidelines also suggest women stop cervical screening around age 65 to 70, as long as she has had three negative tests in the last 10 years. Women who have had a hysterectomy for benign reasons do not need to be screened.
“A key point remains that most women who die from cervical cancer have never been screened, or have not been screened in at least 5 years,” says Saslow. “A well-proven way to prevent cervical cancer is to be screened, because screening can find pre-cancers before they can turn into invasive cancer.”
The ACOG and American Cancer Society each recommend women learn about the potential benefits, harms and limitations of cervical cancer screenings from their healthcare provider.
Lynette Summerill, is an award-winning journalist who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events.
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It would be better to tell women the truth and show some respect for informed consent - doctors have no trouble when they're dealing with men - they got the truth about PSA testing very quickly!
May 20, 2011 - 5:18am21 is still far too young and is no benefit to these young women, but exposes them to high risks from over-detection and over-treatment. (which can damage the cervix and lead to other issues - infertility, cervical stenosis, (infections, endometriosis and may require surgery) cervical weakening and miscarriages, high risk pregnancy, more c-sections and premature babies)
"No country in the world has shown a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical screening. Many countries do not perform cervical screening in women under 30". (Taken from "Cervical cancer screening" in "Australian Doctor" 2006 by Assoc Prof Margaret Davy, Director, Gyn-Oncology, Royal Adelaide Hospital and Dr Shorne - on line)
You should also know that young women produce lots of false positives, one in three pap tests are "abnormal" in women under 25 - false positives caused by the pap picking up normal changes in the maturing cervix or from harmless and transient infections. So, testing before 30 causes great harm for NO benefit. The very rare case that occurs in a young woman is usually missed by the pap test as well - these women get false negatives probably because young women tend to get adenocarcinoma, an even rarer form of cervical cancer that is usually missed by the pap test.
Dr Raffle, UK cancer screening expert and a consultant to the UK cervical screening program completed some amazing research that was published in the British Medical Journal in 2003, "1000 women need regular smears for 35 years to save ONE woman from cervical cancer"...the cancer is rare and was in natural decline before screening started - there are no randomized controlled trials for pap testing so we'll never know for sure whether anyone is helped by pap testing, but if they are, the numbers are small, less than 0.45%. The other factors contributing to the reduction in cases and deaths - better condoms, more hysterectomies (1 in 3 by age 60 in the States!), better hygiene and stronger immune systems with a good standard of living and less STD.
The situation in the States is abusive - including women not yet sexually active from age 21 exposes them to harm for zero benefit. Over-screening increases the risk for no additional benefit - testing women who've had full hysterectomies for benign conditions is pointless. There is no respect for informed consent in women's cancer screening.
In the States even though no medical associations recommend pelvic exams and pap tests before prescribing the Pill, most doctors still coerce women into these exams and test IN EXCHANGE for the Pill - this is coercion, plain and simple. Your doctors even refuse other medications until women submit to their unnecessary and potentially harmful demands. The abuse continues....
In Australia routine pelvic and breast exams are not recommended - they don't help, but expose you to harm. Pap testing is an elective cancer screening test like PSA testing and colonoscopies - options, nothing more....
As a low risk woman I made an informed decision not to have pap tests more than 25 years ago and more recently declined mammograms. Every woman should look at her risk profile, get to the actual benefits and risks of the test and make up her own mind - it's not your doctor's decision. It's your body....
Finland has the lowest rates of cervical cancer in the world and sends the fewest women for colposcopy/biopsies - they offer 5 to 7 tests in total - 5 yearly from age 30 - even this program sends 35%-55% of women for colposcopy/biopsies, but it's the best you'll do with this unreliable test.
The facts are at Dr Joel Sherman's medical privacy under women's privacy issues Pts 1 to 6 - see articles by Dr DeMay, Dr Raffle, Prof Baum and others.
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