Right in the middle of the national firestorm about Mammogram recommendations, the American College of Gynecologists (ACOG) has issued new guidelines for screening of cervical cancer. After 40 years of successfully convincing women to get pap smears annually, the new recommendations say women should not get their first pap test until age 21 and the intervals for testing can then be stretched out.
The new recommendations say that women should start pap screening at age 21 (not teens who are sexually active as previously recommended) and then every two years through age 29. Women age 30 and over with three negative pap smears can stretch it out for three years. Women over age 65 can stop getting pap tests if their previous tests have been negative. Women who have had a hysterectomy for non-cancer reasons never need a pap smear.
The study experts looked at pooled data from around the world. We now know that cervical cancer is caused by certain strains of Human Papillomavirus (HPV), however most women infected with HPV will not develop cervical abnormalities. Most women who contract HPV have an effective immune system that clears the virus. Paps that are done too frequently can show abnormalities that would, in the majority of cases, clear spontaneously.
The researchers also found that pap tests are difficult to interpret and there is inconsistency among cytologists reading the slide. Upon a second review, most results that were reported as showing abnormalities were downgraded to normal.
The study points out that abnormal pap tests lead to a sequence of further testing, biopsies and excisional procedures that can adversely affect a young woman's reproductive health.
In summary, the new guidelines recommend:
- Start pap smears at age 21 regardless of prior sexual activity (no need at all in virgins).
- Test every 2 years to age 30
- After age 30, test every 3 years if prior tests are normal
- Stop at age 65 if prior tests have been negative.
- No paps needed for women who have had hysterectomy if there was no cancer
The 12 page recommendations from ACOG can be found here.