Cervical Cancer Screening Guidelines Updated

Women Over Age 30 Receive New Recommendation

New evidence supports existing recommendations that Pap tests be performed only once every three years for women who are at a low risk for cervical cancer.

For women over the age of 30 who have already had negative annual Pap tests at least three years in a row, extending the interval between tests increases the risk of cervical cancer only by about three in 100,000 women, says a report in the New England Journal of Medicine.

The Pap test, which detects abnormalities in cells before they actually become cancer, is the most widely used cancer-screening test in the US. More than 80 percent of women get the test in any two-year period and more than 90 percent have been screened at least once.

Since the test was adopted in the 1960s, the number of deaths from cervical cancer have dropped dramatically.

Guidelines Set, But Opinion Varies

Guidelines from the American Cancer Society and the American College of Obstetrics and Gynecology recommend that low-risk women - those over the age of 30 with previous negative tests - get Pap tests less often than annually.

Experts say that many physicians still offer tests more frequently, however.

"Reasons are myriad, including the lack of information on risk," says study author Dr. George F. Sawaya, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of California at San Francisco.

The information in the current study, he adds, can be used by physicians and patients to make decisions about how often to screen.

Dr. Sawaya and his colleagues looked at about 1.2 million records from the National Breast and Cervical Cancer Early Detection Program, which is administered by the Centers for Disease Control and Prevention (CDC) and has provided screening to low-income, under-insured, or uninsured women in the US since 1991.

The researchers looked at the number of positive Pap tests and then calculated the estimated cancer risk.

The estimated extra risk of cancer for women ages 30 to 44 who have had three consecutive negative tests was two in 100,000 women, for women ages 45 to 59 it was one in 100,000, and for women 60 to 64 years it was one in 100,000.

The overall cancer risk in each group would then be five in 100,000, two in 100,000, and one in 100,000 respectively. Having annual Pap tests produced no difference in the oldest age group.

The prevalence of cancer decreased as the number of previous negative tests accumulated. Although the risk per woman is small, the overall numbers are larger.

"Five per 100,000 cancers missed with tri-annual screening is small, but when you look at the population, that's 500 extra cancers. That's not so small," says Dr. Giuseppe Del Priore, an associate clinical professor of gynecologic oncology at New York University School in New York City.

There are also other advantages to going in for an annual Pap smear, Dr. Del Priore says.

"To consider a Pap smear a 30-second technical intervention that takes place in some kind of automated void is mistaken," he says. "When a woman who goes to a doctor says everything's fine, she doesn't mean just the Pap smear's fine. She means the blood pressure, weight, tobacco, and vaccination."

Women Advised to See Physician

Still, Dr. Sawaya and others believe the frequency of screening can be reduced for many, but not all, women.

"The information [in the current study] only applies to women over the age of 30 who have had three annual negative Pap smears," says Dr. Sarah Feldman, author of an accompanying editorial and director of the Pap smear evaluation center at Brigham and Women's Hospital in Boston. "It does not apply to the general population."

Dr. Sawaya advises, "Individual women should first and foremost speak with their clinicians to see if they are indeed good candidates for less screening if they desire to be screened less often than annually."

Always consult your physician for a diagnosis.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

American Cancer Society

Centers for Disease Control and Prevention (CDC)

College of Obstetrics and Gynecology

HealthierUS.Gov

National Institutes of Health (NIH)

National Women's Health Information Center

December 2003

Cervical Cancer Screening Guidelines Updated

Guidelines Set, But Opinion Varies

Women Advised to See Physician

Who Should Have Pap Tests?

Online Resources

Who Should Have Pap Tests?

A woman should always consult with her physician about when and how often a Pap test and pelvic examination should be performed.

According to the National Cancer Institute (NCI), the American Cancer Society (ACS), and the American College of Obstetrics (ACOG), general guidelines include:

Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.