Pap Smear Guidelines for Cervical Cancer Screening

Comedian Kathy Griffin gets a public pap smear on camera in order to promote women's health awareness at the Palomar Hotel on April 16, 2010 in Westwood, California. (Photo by Angela Weiss/Getty Images). Photo: Angela Weiss/Getty Images

The American College of Obstetrics and Gynecology (ACOG) Pap Smear Guidelines

(updated 8/16/15)

The following routine screening guidelines apply only to women who are HIV negative, do not have any other immune system disorders, have never had cervical cancer, and were not exposed to diethylstilbestrol (DES) before birth.

  • Starting at age 21, women should receive a Pap smear no more often than every three years - until the age of 29. They should not be tested for HPV
  • Women over the age of 30 should continue to get a Pap smear every 3 years, or they can get a Pap smear and HPV test every five years. The combined test is the preferred option
  • For women over the age of 65 with a history of negative Pap smears, cervical cancer screening can be stopped altogether, as long as certain requirements have been met. Specifically, if there have been two negative combination tests in the last 10 years (one within 5 years), or three negative Pap smears, there is no longer a need to continue screening.
  • Women who have had complete hysterectomies do not require cervical cancer screening.

Until November of 2009, the ACOG Pap smear guidelines had suggested that women start getting annual Pap smears 3 years after they became sexually active or at age 21 - whichever came first. Then they moved to starting later and screening every other year; however, that was still too frequent.

These new guidelines are more similar to the updated American Cancer Society recommendations issued earlier in 2012.

Why Change the Cervical Cancer Screening Guidelines?

The change in cervical cancer screening guidelines reflects the fact that many times early pre-cancerous cervical changes revert on their own and do not require treatment.

Although the Pap smear itself isn't dangerous, too much follow up can be. Unnecessary treatments and invasive diagnostic tests can sometimes cause more harm than good, potentially impacting a young woman's future fertility and health. The scientists who revised the guidelines believe that the cost of the small number of invasive cancers that will be missed by postponing screening is more than outweighed by the benefits to the health of the many women who would have been harmed by being over treated.

My Take On The Changes

Although I am somewhat concerned that these new cervical cancer screening guidelines may also have a negative impact on other STD screenings, a concern that has been born out by the evidence in the years since they have been implemented, I can see that reducing the frequency of cervical cancer screenings is a more palatable way of reducing the problems with follow-up than changing treatment guidelines. Unfortunately, once a problem has been detected on a Pap smear it can be difficult to convince patients that it may resolve on its own and treatment may not be necessary.

"Wait and see" is often not the most appealing option to a patient worried about cancer. There is also the legitimate concern that failure to treat, even when appropriate, may open up physicians to the possibility of lawsuits.

Sources:

The American College of Obstetricians and Gynecologists (September 2013). "New Guidelines for Cervical Cancer Screening." Women’s Health Care Physicians Patient Education Fact Sheet PFS004: New Guidelines for Cervical Cancer Screening. Retrieved 8/16/15 from http://www.acog.org/-/media/For-Patients/pfs004.pdf?dmc=1&ts=20150816T1555125973

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