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.