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
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
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December 2003
In
This Issue:
Cervical
Cancer Screening Guidelines Updated
Guidelines
Set, But Opinion Varies
Women
Advised to See Physician
Who
Should Have Pap Tests?
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Women's
Services at St. John's Mercy
Women's
Health Information
St.
John's Mercy Classes and Programs
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:
- Cervical
cancer screening should begin approximately three years after
a woman begins having sexual intercourse, but no later than at
21 years old.
- Experts recommend
waiting approximately three years following the initiation of
sexual activity because transient human papillomavirus (HPV) infections
and cervical cell changes that are not significant are common
and it takes years for a significant abnormality or cancer to
develop. Cervical cancer is extremely rare in women under the
age of 25.
- Women should
have a Pap test at least once every three years.
- The ACS
and ACOG recommend annual cervical cytology screening
with regular Pap tests or biannual (every two years) screening
with liquid-based tests (Thinprep) until age 30. Women under age
30 have a higher likelihood than older women of acquiring high-risk
types of HPV that cause premalignant cervical disease, which should
be ruled out before extending the testing intervals.
- ACS
and ACOG recommend that at or after age 30, women
who have had three normal test results in a row may get screened
every two to three years. However, women with certain risk factors
such as human immunodeficiency virus (HIV) infection, a weak immune
system, in utero DES exposure, or a previous diagnosis of cervical
cancer may need more frequent screening.
- Women 65
to 70 years of age who have had at least three normal Pap tests
and no abnormal Pap tests in the last 10 years may decide, upon
consultation with their healthcare provider, to stop cervical
cancer screening.
- Women who
have had a total hysterectomy (removal of the uterus and cervix)
do not need to undergo cervical cancer screening, unless the surgery
was done as a treatment for cervical precancer or cancer.
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.
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