Dr. Noelle Roberston has authored a great update regarding some changes to annual pap smear recommendations:
Recently, the U.S. Preventive Services Task Force announced new recommendations for Pap tests to screen women for cervical cancer. The American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP) agree with these new recommendations. The USPSTF guidelines were published in the Annals of Internal Medicine. The ACS, ASCCP and ASCP guidelines were published jointly in CA: A Cancer Journal for Clinicians, the Journal of Lower Genital Tract Disease and the American Journal of Clinical Pathology.
The new guidelines advise women to reduce the frequency of pap tests over their lifetime. This will ensure that women receive the benefits of testing while minimizing the risks. Cervical cancer is caused by infection with certain type of human papillomavirus (HPV). It takes many years to develop cervical cancer after HPV infection occurs. Often HPV can take more than a decade to progress to cervical dysplasia or cancer. Pap tests look for abnormal cells that are in the process of changing from normal into cervical cancer. However, in many cases a woman’s body can fight off the HPV virus before it causes problems, and many early cervical lesions disappear on their own without residual effects. The younger a woman is, the better the chance that her body can get rid of the virus or early lesions. Therefore, testing all women yearly means many women will be treated unnecessarily for issues that never would have harmed them. Unnecessary treatment can be a problem, since treatment can be painful and costly, and can cause cervical incompetence and miscarriage later on.
It is important to note that the guidelines apply only to women at low risk for cervical cancer. Most women are low risk. Factors that make a woman high risk include being HIV positive, being immunocompromised, having been exposed to (diethylstilbestrol) DES in utero, smoking, and having a history of cervical cancer or significantly cervical dysplasia (abnormal cells) in the past. These women need more frequent screening and should discuss this with their doctor.
Here is a summary of the new guidelines:
• All women should start screening at age 21. No longer is screening recommended younger than 21 years old, even if the woman has been sexually active for several years.
• Women aged 21 to 29 should get a Pap test every three years. The statement specifically recommends against annual Pap testing.
• For women 30 and over, Pap tests should be done every three to five years. If the pap test is done along with an HPV test and both are normal, then pap test can be done every 5 years.
• Screening is not recommended for women 65 or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the past 10 years, or who have had two or more negative HPV tests in the past 10 years.
• Women who no longer have a cervix due to hysterectomy no longer need pap smears, as long as the hysterectomy was NOT done due to cervical cancer or dysplasia.
• Having been vaccinated for HPV does NOT change these guidelines. Women who have been vaccinated against HPV (ie the Gardasil vaccine) should still begin cervical cancer screening at age 21 and follow the same timeline as unvaccinated women.