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New Cervical Cancer Screening Guidelines Say Wait


Women are being told they can wait until they are 21 before they have their first Pap test for cervical cancer, even if they have been sexually active for several years before that time, according to the American College of Obstetrics and Gynecologists (ACOG). These new guidelines make changes to recommendations that the ACOG issued only seven months ago.

The new ACOG guidelines say that women can wait until they are 21 for their first test regardless of when they began sexual activity, be screened every other year until they reach age 30, and then schedule the test every three years if no concerns show up on three consecutive tests. Women who demonstrate an increased risk, however, should be screened more often.

The recommendations issued by the ACOG in April 2009 were more stringent. Although they noted that women younger than 21 who had never been sexually active did not need a routine pelvic exam or cervical cytology, those who had engaged in sexual activity should undergo cervical cytology three years after onset of activity and annually thereafter. The ACOG also recommended annual pelvic exams and cervical cytology for women aged 21 to 29, and then annually for women aged 30 to 64 unless they had three consecutive normal tests, in which case screening could be reduced to every 2 to 3 years.

The American College of Obstetrics and Gynecologists made the changes after it concluded that more frequent testing did not detect significantly more cases of cervical cancer and often placed women under undue stress and unnecessary treatments because of suspicious growths that did not require attention. Overall, the ACOG felt that the benefits of more frequent screening were outweighed by the downsides, according to Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico, who headed the guideline revision.

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The National Cancer Institute reports that cervical cancer is usually a slow-growing cancer that may not have symptoms but can be detected during a Pap test. The estimated number of new cases of cervical cancer in the United States in 2009 is 11,270, and estimated deaths is 4,070.

The National Cervical Cancer Coalition, a patient advocacy group, has endorsed the new guidelines, while the American Cancer Society notes that it will consider them in reevaluating its own recommendations, according to a Washington Post article.

The reason screening for cervical cancer is geared around a woman’s sexual activity is because the cancer is caused by a sexually transmitted virus called the human papillomavirus (HPV). This has led many medical groups to recommend that women begin having yearly Pap tests within three years of becoming sexually active.

The new ACOG guidelines were based on evidence that while HPV and abnormalities caused by the virus are relatively common among females who are sexually active, the abnormalities often resolve themselves on their own and cervical cancer rarely develops, especially at the youngest ages. The ACOG also concluded that because cervical cancer is slow-growing, waiting to detect it at age 21 does not pose a significant danger. Women who have any questions or concerns about cervical cancer and screenings should contact their healthcare provider.

National Cancer Institute
ACOG Committee Opinion. Obstetrics & Gynecology 2009 May; 113:1190-93
Washington Post, Nov. 20, 2009