New Updates in Pap Smear Screening Guidelines – Women’s Health of Central Massachusetts
by: Dina Deldon-Saltin, M.D.
Cervical cancer rates have fallen more than 50% in the United States in the last 30 years. This drop can be attributed to the widespread use of the Pap test. The Majority of deaths from cervical cancer in the US are among women who are rarely, if ever, screened. Cervical cancer is a slow growing cancer that is caused by certain strains of the human papillomavirus (HPV). HPV is an extremely common sexually transmitted disease in women and men, whose prevalence exceeds 85% of the sexually active population.
Despite the prevalence in HPV transmission rates, especially in sexually active adolescents, invasive cervical cancer is very rare in women under the age of 21. The immune system clears the HPV infection usually within one to two years among most adolescent women. This is especially true in healthy, non-smoking women. Dysplasia- HPV related precancerous lesions- are common in adolescents secondary to immature cells on the cervix, however, these lesions usually resolve on their own without treatment.
ACOG revised recommendations:
– Women from ages 21 to 30 should be screened every 2 years instead of annually.
– Women age 30 and older who have had 3 consecutive negative cervical cytology test results may be screened once every 3 years
– Women with certain risk factors may need more frequent screening, including those who have HIV, are immunosuppressed, were exposed to DES (diethylstilbestrol (DES) in utero, have been treated for CIN 2, CIN 3, or cervical cancer.
Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents which can have economic, emotional and future childbearing implications. A significant increase in premature births has recently been documented among women who have been treated with excisional procedures for dysplasia.
Routine cervical cytology testing should be discontinued in women who have had a total hysterectomy for noncancerous lesions as long as they have no history of high-grade CIN. It is also reasonable to stop cervical cancer screening at age 65 or 70 among women who have 3 or more negative cytology results in a row and no abnormal test results in the past 10 years. Women who have been vaccinated should follow the same screening guidelines as unvaccinated women.
Women’s Health encourages every patient to discuss these guidelines with their personal physician.
ACOG District IX Notice, New ACOG Cervical Cancer Screening Recommendations
ACOG Practice Bulletin No. 109: Cervical Cytology Screening