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pap guidelines
New Pap Guidelines for Women: Wait Longer, Get Them Less Often
Annual cervical cancer screenings are no longer recommended by the American College of Obstetricians and Gynecologists, but that's no excuse to skip the test altogether.
By Leah Zerbe
Topics: mammograms, sexual health, women's health
Our experts suggest following the new guidelines. But since they're spaced farther apart, it's very important not to skip a screening.
With more time between Pap tests, it's important that women don't miss a screening.
RODALE NEWS, EMMAUS, PA—For the second time in a week, medical experts have issued new recommendations suggesting women wait longer to start getting common tests used to detect cancer. Friday, the American College of Obstetricians and Gynecologists (ACAG) announced that a women's first cervical cancer screening should be delayed until she turns 21, and then repeated every two years, not annually, as previously recommended. Friday's news came before the dust even settled on Monday's breast-cancer-screening announcement issued by the U.S. Preventive Services Task Force. That group now suggests women of average risk should wait to get their first mammogram until they turn 50 (not 40, as previously recommended), and then opt for the scan only every two years, not annually. "The tradition of doing a Pap test every year has not been supported by recent scientific evidence," says Alan G. Waxman, MD, at the University of New Mexico in Albuquerque, lead author of the document developed by ACOG's Committee on Practice Bulletins-Gynecology. "A review of the evidence to date shows that screening at less-frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful."
THE DETAILS: ACOG has updated its guidelines to reflect those already being practiced in many parts of the world. Here are the new Pap guidelines, to be published in the December 2009 issue of the journal Obstetrics & Gynecology:
• Most women should receive their first cervical-cancer screening at age 21, then undergo cervical screening once every two years until age 30, instead of annually. Previously, guidelines recommended adolescents or young women begin screening three years after becoming sexually active, or when they turn 21, whichever occurs first. But new research shows cervical cancer in teens is extremely rare, and an atypical pap at a young age can lead to unnecessary treatments that can lead to problems related to pregnancy, including a threefold greater risk of needing a C-section, premature births, and lower birth weights that could land the baby in the neonatal unit.
• Women age 30 and older can be rescreened once every three years if they have had three consecutive negative cervical test results (i.e., nothing abnormal was detected).
• Women with certain risk factors may need more frequent screening, including those who have HIV, are immunosuppressed, were exposed in utero to diethylstilbestrol (DES, a synthetic hormone used until the 1970s to prevent miscarriages), or have been treated for cervical intraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer.
• Women who have had a total hysterectomy at any age no longer have to be screened for cervical cancer, as long as they have no history of high-grade CIN.
• ACOG's recommendations on the upper age limit for discontinuing cervical screening remain the same. It is reasonable to stop cervical-cancer screening at age 65 or 70 among women who have had three or more negative cytology results in a row and no abnormal test results in the past 10 years.
• Women who have been vaccinated against HPV should follow the same screening guidelines as unvaccinated women.
Published on November 20th, 2009
Last updated on May 12th, 2010
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Tests
I believe that you have the right to do whatever you want with your body, and that means including or excluding tests, treatments and vaccines. Many of these things were designed to prevent or minimize disease so that we can live longer, healthier lives. I get a check up each year, and I always include a mammogram and a pap (along with monthly self checks for breast lumps). They are tools for detection, but these detection tools do not always have their flaws, that is why they retest before taking any invasive action of there is something found. I would prefer to have extra tests, or even a biopsy, to make sure that I do or do not have cancer. I'm a "need to know" sort of person. Vaccines were designed to immunize against disease. It is not poisoning our bodies to build up antibodies to things that make us sick, or may kill us. We naturally build up antibodies to nasty microbes when we become ill. For example, many of us who have had chicken pox now have antibodies that will prevent us from becoming ill again. We have nearly elimiated things like smallpox and polio throgh vaccines. Two very devastating diseases, nearly gone! I am for annual checkups and definitely support the use of vaccines, including the HPV vaccine!
Tests
I don't get mammograms because there are so many false results both ways and because of the exposure to radiation. However, this isn't the case with a pap. My mother died from ovarian cancer when she was 48. This cancer is nicknamed the "silent killer" because by the time it is caught it has already spread to other organs. This has been known for over two decades. Why would you forgo a risk free test and take a chance. Dumb! On the subject of the hpv vaccine: The evidence for a link between hpv and cervical cancer is very, very weak if even existent at all. Who makes money from vaccines? Millions of people uselessly poison their bodies every year them, yes, including the flu vaccines. The answer is to keep your immune system healthy and it will work properly!
Annual paps- strongly in favor!
I still get a pap every year, even though I'm minus a cervix due to full hysterectomy. My gyn oncologist, one of the best in the country, advised to continue with yearly paps as a preventative measure against vaginal and vulvar cancer. (I did not have cervical cancer) I wonder what ACOG has to say about that?? I'm very concerned that the latest advice/guidelines are not medically sound, and merely in the future monetary interests of the insurance companies. Personally, it won't matter to me whether they cover or not....I will continue to get annual pap tests and do whatever it takes in the best interests of my health. Nothing should take the place of the best clinical advice from one's own physician. I've been alive with superb quality of life for 8 years because I've been my own advocate in partnership with my physician, not listening to someone else's guidelines.
test versus face-time
Forego the annual Pap, but don't forego the annual exam with your gynocologist. Women at any age should have face-time with their doc every year just to touch base.
hpv vaccine
this reassurance about how hpv usually clears up on its own and very few cases lead to cervical cancer is interesting to read. not too long ago the media blitz for the promotion of the hpv vaccine assured moms it was literally saving all our daughters' lives. quite a contradiction to what this article states, wish it had been covered in more than 1 sentence in the article, will that lead to different recommendations regarding which young girls actually need the vaccine? sadly i think not.