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Fewer Pap Tests Urged

By Melissa Tennen, HealthAtoZ writer

Not all women need yearly Pap smears, the American Cancer Society (ACS) says.

Seeking to prevent needless anxiety among women and unnecessary procedures, the ACS, with input from the National Cancer Institute and other leading medical institutions, developed new guidelines for doctors and health care providers.

The norm for the past 15 years has been for all women older than 18 to get a Pap smear. However, the ACS, basing its guidelines on evidence collected in the past several years, says a blanket guideline for all women isn't necessary.

The new guidelines say women older than 70 with normal Pap smears throughout life and those between the ages of 18 and 21 may not need the test. Women should begin getting the test within three years of the start of sexual activity but no later than age 21. And those who have had hysterectomies where the cervix has been removed for reasons other than cancer don't need to be tested. Historically, Pap smear tests have been continued for women who've had hysterectomies because there's no guarantee a hysterectomy removes all cervical cells.

Screening should be done every year for the traditional Pap tests or every two years with the newer liquid Pap test. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. But if a woman has human immunodeficiency virus (HIV) or a weakened immune system, a doctor may suggest yearly tests.

"[The guidelines] are going to be effective in reducing costs but won't compromise women's safety," says Diane Solomon, M.D., senior investigator of the division of cancer prevention at the National Cancer Institute. "The guidelines strike a nice balance between detection sensitivity to protect women and avoiding over-treatment."

Millions of women have abnormal Pap results every year. But fewer than one half of one percent of abnormal Pap smears show cancer. These are causing unnecessary anxiety and fear among some women who don't understand these odds, Solomon says.

Doctors who have no objections to the new ACS guidelines in principle may have a more practical reason for continuing to do annual screenings.

"If your talking about cervical cancer, that makes sense, but if you're talking about overall health, that doesn't make sense," Scott A. Dinesen, D.O., in private practice in Doylestown, Pa., says of the recommended cutbacks.

Dinesen said he was concerned that the reduced recommendations might discourage women from getting a full pelvic examination every year. Whether or not an individual needs a Pap smear every year, he still believes some kind of yearly gynecological exam is indeed necessary for early detection of other cancers and other conditions which occur in that zone of the body.

"People tend to take their cars in for service more often than they get themselves to a doctor," Dinesen said.

Cervical cancer mortality has decreased by more than 70 percent in the past 50 years, according to ACS. Cervical cancer was once the number one cancer for women in the United States. It now ranks 13th in cancer deaths for women. In 2002, about 13,000 cases of invasive cervical cancer were diagnosed and an estimated 4,100 women died from this disease. However, when this very slow growing disease is caught at an early stage, the five-year survival rate is about 92 percent.

Infection of the cervix with human papillomavirus, a sexually transmitted disease, is the most common cause of cervical cancer. And many women have it. However, the vast majority of women with the infection do not develop cancer.

Most cervical precancers grow very slowly. And the majority of (HPV) infections go away on their own without causing cancer.