Friday, November 20, 2009

New Guidelines on Pap Smears for Women

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
It is ironic that we now have two significant changes for screening tests in women's health. According to the chair woman of the ACOG study group, Dr. Cheryl Iglesia, it was a bizarre coincidence that their guidelines hit right at the same time as the mammogram controversy.

The 12 page recommendations from ACOG can be found here.


Anonymous said...

More is not better. It is time Americans understand this. The Europeans have been following these "new" guidelines for years and their longevity and health status exceeds ours for a fraction of the cost. Kudos to ACOG for looking at the evidence objectively and not just focusing on the industry's revenue stream.

Anonymous said...

Although,Dr.Brayer do you agree it does seem like you should still go once a year to get your ovaries checked and a breast exam by your gyn or primary on the years excluding the pap and mammogram?

Do they have any guide lines of when to do pelvic and tranvaginal sonograms when you have a family history of ovarian cancer?

Toni Brayer MD said...

Anon: It is important to differentiate cancer screening (pap) tests from other preventive visits. Women should still have regular annual visits with a pelvic exam and other health risk screens (blood pressure, cholesterol, lifestyle, diet, breast exam) etc.

A family history of ovarian cancer may entail ultrasound and certainly pelvic exams and mammogram as it may put a woman at higher risk.

Michael Kirsch, M.D. said...

We need to be guided by data and science, not politics and emotion. The mammography mania shows how we failed at this task. In addition, we need to educate folks that more medical care often means inferior health. Folks cannot expect to be entitled to every available medical benefit, regardless of cost, particularly if medical evidence does not support its use.

Toni Brayer MD said...

MichaelKirsch: Well said

mitchsmom said...

Do you know the guidelines if prior ASCUS cells or HSV?

Toni Brayer MD said...

mitchsmom: Both HPV and ASCUS can reverse with no treatment, according the the research. Both would require a repeat pap but after three normal paps, ACOG says follow the regular guidelines...(every other year until age 65-70..then can stop).

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