Blog | Wednesday, January 11, 2012

Women don't need as many Pap tests




Women have been told they should have screening for cervical cancer with a Pap test every year. The visit to the gynecologist or internal medicine physician has been a right of passage for most young women and most are very compliant with that annual visit throughout their lives.

Well, the times they are a-changin' because new guidelines issued by the U.S. Preventative Services Task Force and the American Cancer Society say women should undergo screening NO MORE OFTEN than every 3 years starting at age 21. To further strengthen this recommendation, even the American Society for Clinical Pathology (those folks that read the Pap smears) agrees with the recommendation. They also recommending stopping routine Pap smears after age 65 for women who have had 3 negative Pap test results in the past 10 years. These women are just not at high risk.

So why the change?

The Pap smear is a screening test for cervical cancer. Evidence shows that more frequent screening than every 3 years doesn't find more cancer and we now know that cervical cancer is the result of infection with human papillomaviruses (HPVs). Women that have not been exposed to HPV are not at risk of cervical cancer. Furthermore, out of 150 related viruses, of which 40 are sexually transmitted, only certain ones are high-risk, oncogenic (or carcinogenic) HPVs. Persistent infections with these high-risk HPV types can cause cell abnormalities that are picked up on pap tests. But the majority of infections with even high-risk HPV types go away on their own and do not cause cancer. Two types of HPV (types 16 and 18) cause 70% of all cervical cancers and they are very slow growing.

When a Pap test detects cervical cell changes, an HPV DNA test is usually done. If the HPV test is negative, a women is safe from cervical cancer for many years. Even if a pap test shows equivocal changes, if the HPV test is negative, it is recommended she be re-tested in 3 years.

Despite these recommendations, annual testing remains a common practice in most gynecology offices. Even in women who have been tested for HPV and found negative, less than 15% of physicians recommended that patients wait 3 years before repeat testing. Women are still being told to come back annually.

Why?

Some doctors may not know about the guidelines, even though they are also supported by the American College of Obstetricians and Gynecologists. Doctors as well as patients are in the habit of "the annual Pap test." Doctors are also concerned that if they don't recommend Pap smears, women will not come in for an annual exam and other preventive screening. But doing unnecessary testing is not a way to have women come in.

For most women this will be a welcome change. Stretching out those gynecologic screening exams will save time, money, false positive tests and unneeded follow-up. Keep in mind this only refers to non-symptom screening. Women who have any gynecologic symptoms (unusual bleeding, discharge, pain, pressure) or any other concern or questions should see their physician.

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.