Panel says no need for annual Pap tests – Columbus Dispatch
Women don't need a Pap test until they're 21, and most don't need tests every year, according to new advice from the American College of Obstetricians and Gynecologists.
The virus that causes cervical cancer and leads to abnormal Pap results -- human papilloma virus, or HPV -- almost always goes away in young women, and cervical-cancer diagnoses are almost unheard of in women younger than 21, said Dr. David Soper, the head of the committee that wrote the recommendations.
The advice comes a few days after hotly contested recommendations from the U.S. Preventive Services Task Force regarding screening for breast cancer. Among other things, the panel, which advises the government, said most women don't need mammograms until they're 50. Past recommendations said women needed them starting at 40.
Many gynecologists, radiologists and oncologists have cried foul, pointing out that mammography detects many cancers in women younger than 50 and as a result saves lives.
Other than expressing concerns that women might be tempted to forgo important annual exams, doctors say they can understand the cervical-screening changes and don't worry that less-frequent screening will amount to lost lives.
Cervical cancer is a relatively slow-moving disease. It will be diagnosed in approximately 11,270 women this year, according to the American Cancer Society. About 4,070 women will die of it.
"Early minor changes in the Pap smear don't require therapy at all, and there's new information to suggest that treatment of the cervix for dysplasia (abnormal cells) may increase the risk of preterm labor," said Soper, vice chairman of the obstetrics and gynecology department at the Medical University of South Carolina in Charleston.
About 85 percent of HPV infections eventually go away, he said, and most are found in young women. Eliminating unnecessary screening, diagnostic tests and treatment in that population prevents complications (primarily damage to the cervix), and eliminates unnecessary anxiety and stigma surrounding HPV infection. It also will save money, according to the recommendations.
Treatment includes removal of part of the cervix or ablation either by freezing or use of a laser. Unnecessarily treating women who will never develop cancer can weaken the cervix, making it difficult for them to carry babies to term.
Women 21 to 29 should be screened every other year, rather than every year, the committee said. And those 30 or older who've had three consecutive negative screenings and no history of cervical problems or other complications can go three years before the next test, they said.
Screening can safely be stopped when women are between 65 and 70, they said.
Dr. Jeffrey Fowler, director of gynecologic oncology at the Arthur G. James Cancer Hospital, said he agrees with all of the guidance but remains worried about the women who never get a Pap test, or go too many years between tests.
"The most important thing is that they be done," he said.
Half of the cervical-cancer diagnoses each year are in women who have never had a Pap test. Another 10 percent had not been screened within five years, according to the National Institutes of Health.
Annual exams remain essential to women's health, particularly in the reproductive years, doctors say.
Problems can be detected through annual physical exams, and they also provide an opportunity for doctors to talk to their patients about things such as losing weight and quitting smoking, he said.
"I agree with all their opinions," said Dr. Jeffrey Bell, medical director of cancer services at Riverside Methodist Hospital.
Bell, an OB-GYN, said doctors have been talking about less-frequent Pap tests for years, and some already have applied that to their practices.
Change in practice based on the new recommendations could take several years, but likely will be widely accepted, Soper said.
By contrast, the breast-exam recommendations that drew such ire this week are unlikely to prompt much change in practice.
Concern that insurers would stop covering mammograms even prompted the Obama administration this week to say government insurance will continue to cover routine screening starting at 40 despite the recommendations.
The American College of Obstetricians and Gynecologists issued a statement saying it still supports routine screening at 40.
Bell said he supports that and thinks the prudent approach for women is to follow established mammography recommendations as national experts continue to debate whether the guidelines should be modified.
The Pap recommendations are better rooted in science, and come with less risk to patients, Soper said.
"(The college) cannot get on board for the mammography issues. And I can't personally."
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