The American College of Obstetrics and Gynecology has since the publication of its last guidelines in 2006 radically changed the screening schedules for cervical cancer in younger women - those under age 21.
Previous recommendations were for Pap screening within three years of the onset of sexual activity or by age 21. Prior to this, screening was recommended within three years of onset of sexual activity or by age 18.
As of 2009, recommendations are to do no cervical screening or HPV testing at all in those women under the age of 21. While research has shown that the rates of HPV (human papillomavirus) are very high in this age group and that the majority of these regress within 24 months, approximately 20 percent of individuals will be shown to have persistent infections. It is the presence of HPV accompanied by persistent infection which is most likely to progress to serious precancerous lesions and cancer itself. HPV has already been associated with six different cancers in both men and women.
Mention is made of the importance of counseling those in this age group and in testing them for STIs during routine visits. However a full two-thirds of the women with whom I have communicated received little or no counseling at all and it is interesting that while testing for STIs is recommended, HPV testing is not included.
Does a woman not have a right to know if she is harboring a very contagious virus despite her age? And what about any future partners with whom she may come in contact? HPV is highly contagious and can be transferred during just one sexual encounter. Do her potential partners not have the right to decide whether or not they wish to become involved in a situation which may induce cancer in themselves?
ACOG states that early screening can lead to unnecessary and even harmful evaluations and treatments in women with very low risks of cancer. However it is not the early screening itself that produces these negative issues but what is done with the results of these screening tests. After all, it is their own guidelines which instruct the physician regarding how to proceed depending upon the results. A direct contradiction in terms.
Has the medical community become so complacent with the high percentage of Americans becoming infected with HPV (80 percent at some time in their lives) that they would introduce guidelines which delay a woman’s diagnosis thus maintaining the status quo of contagion or worse? Is the cost-effectiveness of delaying screening taking priority over the best interest of the patient in whom an early diagnosis is crucial? It certainly does appear that way.
And what about the psychological effects on women including the guilt of knowing that they have exposed their partners? When the medical community fails to treat the patient as a whole - physically and psychologically - and when cost-effectiveness takes priority, we have indeed begun the a journey down a very slippery slope.
Sources:
Cervical Cytology Screening: The Impact of the New ACOG Guidelines.
Center for Health Training.org. Retrieved August 7, 2011 from
http://www.centerforhealthtraining.org/calendar/onlinetrainings/documents/e06_04-09PapSmear_Presentation.pdf
Changes in the 2010 STD Treatment Guidelines: What Adolescent Health Care Providers Should Know. (n.d.).American Congress of Obstetricians and Gynecologists. Retrieved August 7, 2011, from http://www.acog.org/departments/dept_notice.cfm?recno=7&bulletin=5545
First Cervical Cancer Screening Delayed Until Age 2, Less Frequent Pap Tests Recommended. For Release: November 20, 2009. The American College of Obstetricians and Gynecologists (ACOG)
Retrieved August 7, 2011 from http://www.acog.org/from_home/publications/press_releases/nr11-20-09.cfm
Reviewed August 8, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith