The American College of Obstetricians and Gynecologists (ACOG) has released new Pap smear guidelines for women. In a study released in the December 2009 issue of Obstetrics and Gynecology, the newly revised guidelines state that women should begin receiving their first test at age 21. This is differs from the previous standard, which called for women receiving their first Pap smear at age 21 or within three years of becoming sexually active.
ACOG’s new standards also call for screenings every other year for women between the ages of 21 and 30. Women 30 and older are now being told to have screenings every three years after they have had three clear tests in a row. Previously, the group had recommended a two to three year wait for women in this demographic. ACOG does provide a warning that women with HIV or other immune-suppressing diseases, or who have had cervical abnormalities should get more frequent tests. They are also recommending that women who have been vaccinated against HPV (human papillomavirus)–which is the virus that causes cervical cancer–follow the same guidelines as those who have not received the vaccine.
Women who have had a total hysterectomy for noncancerous reasons and have not been treated for cervical abnormalities can stop having Pap smears under the new guidelines. Those age 65 and older who have had three clear tests in a row and no abnormalities in the past 10 years can stop testing as well, which is the same as the previous standards.
Cervical Cancer Cases in Women
Every year, 11,270 new cases of cervical cancer are diagnosed in the United States and of those, about 4,070 women will die from it, according to the American Cancer Society. Most of those deaths are in women who have not been getting Pap smears, with half of this group never having had the screening, and another 10 percent not having had one in the past five years. This is because cervical cancer is a slow–growing cancer, so when it is detected by a Pap smear, it is usually in the early stages.
In girls ages 15 to 19, only two per million will develop cervical cancer, which is why doctors feel that it is safe to push back screenings to age 21. Even though there is a high rate of HPV among this group, the immune system usually clears the body of the virus within one to two years without developing into cancer.
Potential Harm from False Positive Pap Smear Results
In addition to the rare occurrence of cervical cancer in adolescent women, ACOG cites potentially harmful side effects from the overuse of Pap smears as another factor in their guideline revision.
Because adolescent women have such a high occurrence of HPV, their Pap smear results are most likely to show precancerous lesions. They are then subjected to invasive procedures such as biopsies in order to rule out cervical cancer or to remove the growths. These procedures can injure the cervix, leading to complications if the woman later becomes pregnant, including premature birth and an increased need for a Cesarean section.
Debate Surrounds ACOG Pap Smear Guidelines
Some have questioned the timing of the release of the new guidelines, which comes on the heels of the hotly debated changes in mammogram guidelines for breast cancer screening. ACOG asserts that the timing is purely coincidental and that they had been working on these revisions since 2007.
Medical professionals are concerned that when cutbacks in treatment are announced, those who are in high risk groups may not get treatment at all. In the New York Times article “Guidelines Push Back Age for Cervical Cancer Tests”, Dr. Carol L. Brown, a gynecologic oncologist and surgeon at Memorial Sloan-Kettering Cancer Center, voices her concern that some girls become sexually active as young as age 12 or 13, which could potentially increase their risk for developing cervical cancer.
Others fear that private insurance companies will use the new guidelines as a rationale for no longer covering annual Pap smears, thus making them unaffordable for women who may be at risk for cervical cancer.
As with any medical procedure or question, concerned patients should always consult their doctors before making any changes in their medical care routines. Women should do careful research and take into consideration their risks for developing cervical cancer, including sexual activity and family history when making decisions.
References:
Neergaard, L. (November 20, 2009) Pap smear every 2 years for women in 20s. The Florida Times-Union.
Grady, D. (November 20, 2009) Guidelines push back age for cervical cancer tests. The New York Times.
Alana Tutwiler - Alana Tutwiler is a Contributing Writer for Suite101.com. She has a bachelor's degree in Special Education from the University of North ...
