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ACOG releases new Pap test guidelines

Robin Wulffson MD's picture
Pap test, cervical cancer, HPV, human papilloma virus, screening, guidelines

The American Congress of Obstetrics and Gynecology (ACOG) has released a new practice bulletin concurrent with the November issue of the journal Obstetrics & Gynecology. The organization now recommends that most women only need to undergo cervical cancer screening every three to five years, rather than annually.

The bulletin notes that the incidence of cervical cancer in the US has decreased more than 50% in the past 30 years because of widespread screening with cervical cytology. In 1975, the rate was 14.8 per 100,000 women. By 2008, it had been reduced to 6.6 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.38 per 100,000 women in 2008. The American Cancer Society (ACS) estimates that there will be 12,170 new cases of cervical cancer in the United States in 2012, with 4,220 deaths from the disease. Cervical cancer is much more common worldwide, particularly in nations without screening programs, with an estimated 530,000 new cases of the disease and 275,000 resultant deaths each year. When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (5, 6).

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ACOG notes that new technologies for cervical cancer screening continue to evolve as do recommendations for managing the results. In addition, there are different risk–benefit considerations for women at different ages, as reflected in age-specific screening recommendations. Most cervical cancer occurs in women who were either never screened or were inadequately screened. Estimates suggest that 50% of the women in whom cervical cancer is diagnosed never had cervical cytology testing, and another 10% have not been screened within the 5 years before diagnosis. Thus, approximately 60% of diagnoses of cervical cancer are a result of inadequate screening. Additional public health measures remain critical to improving access to screening for this group of women who are often uninsured or underinsured. Although rates of cervical cancer are on the decline in women born in the United States with access to screening, women who are immigrants to the United States, those lacking a regular source of health care, and the uninsured are at especially high risk.

Cervical cancer is caused by some types of the human papilloma virus (HPV), which is a common sexually transmitted disease (STD). Most women with healthy immune systems are resistant to an HPV infection; however, a small number with persistent HPV infection will develop cervical abnormalities that lead to cancer.

The new guidelines state:

  • Women aged 30 to 65 with normal Pap and HPV tests need screening only every five years. If only a Pap test is available, it is needed every three years.
  • Women aged 21 to 29 should be screened every three years instead of every two years.
  • Women under 21 do not need screening because invasive cervical cancer is rare in this age group.
  • Women 65 and older don't need screening if they have no history of cervical cancer and have had three consecutive normal Pap tests or two consecutive Pap and HPV tests over a 10-year period with the latest test done within the past five years.
  • Women of any age who have had a total hysterectomy, which includes removal of the cervix, and have no history of cervical cancer do not need regular screening.
  • HPV-vaccinated women should follow the same screening guidelines as unvaccinated women.
  • Some women need more frequent screening. They include women who have had cervical cancer, are HIV-positive, have compromised immune systems or were exposed to the drug diethylstilbestrol in the womb.

Reference: The American Congress of Obstetrics and Gynecology