Shots - Health Blog
3:01 pm
Wed March 14, 2012

Doctors Revamp Guidelines For Pap Smears

Women should get screened for cervical cancer far less frequently than doctors have long recommended, according to new guidelines released Wednesday.

More than 12,000 women are diagnosed with cervical cancer every year in the United States, and more than 4,000 die from the disease.

For years, doctors have recommended that women start getting Pap smears every year or two to try to catch signs of cancer early, when it's easiest to prevent and treat.

"Previously we had said screening should start either at age 21 or three years after the onset of sexual activity," says Debbie Saslow of the American Cancer Society, which issued one of the sets of guidelines along with two medical groups.

After reviewing the latest scientific evidence, the groups concluded that annual screening isn't necessary and, in fact, was harmful. Most women should wait until they turn 21, and then only get tested every three years if everything looks OK, according to the guidelines.

"This is the first time that we're saying we recommend against annual screening," Saslow says.

There are a couple of reasons for this change. First of all, cervical cancer is so rare in young women that there's no reason to start any earlier, Saslow says. And even when they're older, cervical cancer grows so slowly that there's no harm in waiting longer between tests.

"If you compare the benefit of annual screening to screening every three years with the Pap test it's almost nothing," she said.

More frequent testing can cause real problems, she says. The Pap tests often produce false alarms, which lead women to undergo procedures to make sure there's no cancer.

And repeating those follow-up procedures over and over can damage the cervix, causing serious problems later if women want to have children, experts said.

"That can include preterm labor and then the birth of a premature infant or low birthweight infant," said Wanda Nicholson with the U.S Preventive Services Task Force, which simultaneously issued almost identical recommendations. Those recommendations, along with an accompanying editorial, were published in the Annals of Internal Medicine.

The guidelines also for the first time say that when women turn 30, they can get the Pap test along with a test for the human papillomavirus, a sexually transmitted virus that can cause cervical cancer. If both tests come back negative, then most women women can wait at least five years to get the tests again, according to the guidelines.

"The addition of this HPV test adds so much accuracy to the result that screening more frequently than five years will again be more harmful and not more beneficial," Saslow says.

The new guidelines also recommend women stop getting screened all together once they turn 65 and everything still looks OK.

Some previous recommendations to cut back on other cancer screeening tests, such as the U.S. Preventive Services Task Force's questioning of mammograms for breast cancer for younger women and PSA tests for prostate cancer, have triggered fears about rationing care. But Saslow said that's not the case.

"When people hear, 'Less is potentially better, more is harmful,' the assumption is you're trying to ration care--you're trying to save money. And absolutely that is not true," she says.

Still, some doctors are a little worried that eliminating the annual exams may make some women forget to get their Pap tests, or fail to come in for other tests that are important for a woman's well-being.

"We have to unlink the Pap test from the well-woman exam," said Juan C. Felix of the University of Southern California, who chairs the medical advisory panel of the National Cervical Cancer Coalition.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

Several leading medical groups today issued new guidelines for cervical cancer screening. They recommend that women get screened far less frequently than doctors have long recommended. As we hear from NPR's Rob Stein, the new advice is the latest in a series of recommendations urging doctors and patients to be more cautious about common cancer screening tests.

ROB STEIN, BYLINE: More than 12,000 women are diagnosed with cervical cancer every year in the United States and more than 4,000 die from the disease. For years, doctors have recommended that women start getting pap smears every year or two to try to catch any signs of cancer early when it's easiest to prevent and treat.

Debbie Saslow is with the American Cancer Society.

DEBBIE SASLOW: Previously, we had said that screening should start either at age 21 or three years after the onset of sexual activity.

STEIN: But, after reviewing the latest scientific evidence, the Cancer Society and three other medical groups say that's not necessary. In fact, it's a bad idea. Most women should wait until they turn 21 and then only get tested every three years if everything looks OK.

SASLOW: This is the first time that we're saying we recommend against annual screening.

STEIN: There are a couple of reasons for the change. First of all, cervical cancer is so rare among young women that there's no reason to start any earlier and cervical cancer grows so slowly that there's no harm in waiting longer between tests.

SASLOW: If you compare the benefit of annual screening to screening every three years with the pap test, it's almost nothing.

STEIN: And more frequent testing can cause real problems. The pap tests often produce false alarms. Those scares force women to undergo procedures to make sure there's no cancer.

SASLOW: There is time away from work. There is the discomfort, physical discomfort. There's the psychological anxiety.

STEIN: And repeating those follow-up procedures over and over again can damage the cervix, causing serious problems later if women have children.

Wanda Nicholson is with the U.S. Preventative Services Taskforce, which is issuing almost identical recommendations. She says complications can include...

WANDA NICHOLSON: Preterm labor and the birth of a premature infant or a low birth weight infant.

STEIN: For the first time, the guidelines also say that when women turn 30 they can get the pap test along with the test for the human papillomavirus. HPV is a sexually transmitted virus that causes cervical cancer. If both tests come back negative, then most women can wait at least five years to get the tests again.

SASLOW: The addition of this HPV test adds so much accuracy to the result that screening more frequently than five years will, again, be more harmful and not more beneficial.

STEIN: And the new guidelines say women can stop getting screened altogether once they turn 65 and everything still looks OK. Now, previous recommendations to cut back on other cancer tests - mammograms for breast cancer and PSA tests for prostate cancer - have been very controversial.

The Cancer Society's Saslow acknowledges that, whenever anyone talks about doing less medical care, it triggers fears about rationing.

SASLOW: When people hear less is potentially better, more is harmful, the assumption is you're rationing care. You're trying to save money.

STEIN: But Saslow says that's not true. In fact, both Saslow and Nicholson say money was absolutely not a factor in changing the guidelines. Still, some doctors are a little worried that doing away with the annual exams will make some women forget to get their pap tests or fail to come in for other tests that are important for a woman's well-being.

Juan Felix is a cervical cancer expert at the University of Southern California.

JUAN FELIX: We have to unlink the pap test from the well woman exam.

STEIN: One of the big questions will be whether doctors are willing to follow these new guidelines and whether women will feel comfortable getting checked less often for cervical cancer.

Rob Stein, NPR News.

(SOUNDBITE OF MUSIC)

ROBERT SIEGEL, HOST:

This is NPR News. Transcript provided by NPR, Copyright National Public Radio.