The Medical Minute: Experts revise Pap smear guidelines

Most women no longer need annual Pap smear screening exams for cervical cancer, but that doesn’t mean they should see their primary care provider less often. That is according to new guidelines issued this week by the American College of Obstetricians and Gynecologists.

For decades, women were advised to schedule annual “Pap and pelvic” exams to screen for precursors to cervical cancer. The new recommendations for less frequent screening serve to balance the benefits of routine screening for cervical cancer precursors with the harm of unnecessarily detecting abnormalities that will not progress to cancer, including transient infections of human papilloma virus, or HPV, the cause of most cervical cancer. Dr. Josh Kesterson says the decreased frequency of Pap smears accounts for the fact that cervical cancer is slow growing and that most HPV infections are low-grade and tend to go away on their own.

“For the majority of women infected by HPV, it’s a transient infection and will go away all by itself,” said Kesterson, an assistant professor of gynecologic oncology in the Division of Obstetrics and Gynecology at Penn State Milton S. Hershey Medical Center. “You don’t want to have a screening test for something you don’t need to act on, and you don’t want to perform unnecessary procedures for a process that will resolve on its own.”

As has been the recommendation for several years, women younger than age 21 don’t need annual Pap screening exams, regardless of when they began having sexual intercourse or whether they have received the HPV vaccine.

For women at average risk for cervical cancer, the new guidelines suggest:

-- Women in their 20s should have a Pap exam every three years.

-- Women ages 30-65 should have at least a Pap smear every three years. For those who want to space out the interval between Pap smears even further, they may have a Pap exam combined with HPV screening together every five years.

-- Women age 65 and above don’t need annual Pap screening exams or HPV testing.

The new age recommendations are in line with those issued earlier this year by the American Cancer Society and the U.S. Preventative Taskforce, and reflect the typical development of cervical cancer.

Women tend to acquire HPV infections in their teen years and their 20s, when many are most sexually active. But only a few HPV infections will progress into cancer, and that takes 10 to 15 years. That means the Pap exam is still an excellent screening tool, even at reduced intervals, Kesterson said.

“It’s unlikely to have an undiagnosed cervical cancer in that three-year interval,” he said.

After age 65, women who have had adequate prior screening with no prior cervical dysplasia — abnormalities in the cells lining the cervix caused by HPV infection — or cancer or any conditions resulting in immunocompromise, such as HIV, she is unlikely to develop cervical cancer.

Kesterson says the recommendations do not pertain to women with a history of abnormal Pap results, including cervical dysplasia or women with other health issues that make them immune-compromised. These women will need more regular followup by their health care provider.

Also, young women who have received the cervical cancer vaccine still need to follow the guidelines for Pap screening exams, Kesterson says. That’s because the vaccine doesn’t protect against all strains of HPV infection.

Most importantly, though, Kesterson recommends women don’t use the new guidelines as a reason to visit their primary care provider less often.

“Decreasing the frequency of Pap exams to every three years doesn’t reduce the need for an annual exam or the importance of the pelvic exam,” he said. “Women still need those regular ‘well woman’ visits to focus on other aspects of their life during reproductive years, such as contraception, other screenings for breast and colon cancer, osteoporosis and lifestyle changes.”

The Medical Minute is a weekly health news feature brought to you by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Up next week: Breast cancer has been front and center during October, but learn about two other serious cancers — one that affects men and one that affects women — that doctors are looking for ways to better diagnose and treat.

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Last Updated October 25, 2012