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Doctor's Group: Delay Pap Tests Until 21

Doctor's Group: Delay Pap Tests Until 21 Changes Recommended in Schedule of Cervical Cancer Screening WebMD Health News By Salynn Boyles Reviewed by Louise Chang, MD More from WebMD Could...

Nov. 20, 2009 -- Less than a week after a government task force announced controversial recommendations for breast cancer screening, a doctor's group is recommending big changes in cervical cancer screening.

The American College of Obstetricians and Gynecologists (ACOG) now says women should begin cervical cancer screening at age 21, rather than earlier in life.

And the group no longer recommends annual screening for most women.

The new breast cancer recommendations sparked heated debate within the medical community. Even those who support delaying the onset of mammography screening acknowledge that some breast cancers will be missed.

But experts tell WebMD the revised cervical cancer guidelines will not be as controversial.

"The new recommendations for cervical cancer screening really do not miss any cancers," says David E. Soper, MD, who chairs ACOG's Gynecological Practice Bulletin Committee.

"The data are very clear," he tells WebMD. "For women in their 20s, having an annual Pap smear will find no more cancers than screening every two years."

Pap Test Saves Lives

Soper says the call for delayed and less frequent screening does not mean Pap testing is not effective.

Screening is largely responsible for a 50% decline in cervical cancer rates during the past three decades.

"There are still 11,000 new cases of cervical cancer and 4,000 cervical cancer deaths in the United States each year, and most of these could be prevented with adequate screening," Soper says.

 ACOG now recommends:

  • Screening women with Pap testing between the ages of 21 and 30 every two years instead of annually
  • Screening women 30 and older who have had three consecutive normal Pap test results every three years instead of annually
  • More frequent screening for women with risk factors for cervical cancer

Screening can be stopped in women who are 65 to 70 and have had three or more consecutive normal test results and no abnormal test results in the past 10 years.

Women who have been vaccinated against human papillomavirus (HPV) should follow the same screening guidelines as unvaccinated women.

Even if a Pap test isn't due, doctors should let their patients know that annual gynecologic exams may still be appropriate.

The Case Against Screening Teens

ACOG's previous guidelines called for cervical cancer screening to begin three years after a woman becomes sexually active or by age 21, whichever occurs first.

Many women become infected with sexually transmitted HPV, but most women's bodies get rid of the infection naturally. Most women who get infected don't develop cervical cancer, and there are other causes of cervical cancer.

But while active infection can be common in women younger than 21, cervical cancer is remarkably rare.

"It literally occurs in about one in a million women younger than 21," Soper says.

Since about 85% of women who become infected will clear the HPV virus within a few years, delaying screening until age 21 will prevent unnecessary surgical treatment to remove suspicious lesions.

Such treatment has been linked to an increase in premature births.

"Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own," ACOG's Alan G. Waxman, MD, says in a news release.

Ob-gyn Mark H. Einstein, MD, agrees. He directs the division of gynecologic oncology clinical research program at New York's Montefiore Medical Center.

"The vast majority of abnormalities identified though early screening are clinically irrelevant manifestations of [transient] HPV infection," he tells WebMD. "Early screening stigmatizes young women and subjects them to extra testing and unnecessary treatment."

Perspective of American Cancer Society

The American Cancer Society, which was highly critical of the mammography changes, supports the new ACOG cervical cancer guidelines.

Last June, representatives from the American Cancer Society, ACOG, and close to 25 other health groups met to discuss cervical screening and management for adolescents.

According to American Cancer Society Director of Breast and Gynecologic Cancer Debbie Saslow, PhD, there was general agreement that for most women, screening should begin at age 21.

Saslow says in a news release that overscreening has lead to overtreatment of young women. But she also says that underscreening of women who should have regular Pap tests leads to death. "Most women who die from cervical cancer have never been screened or have not been screened in at least five years."

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