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Fewer Pap Tests OK for Some Women

New Guidelines Aim to Cut Unneeded Screening
By
WebMD Health News

Nov. 15, 2002 -- Pap tests save lives, but they are an invasive and often dreaded part of a trip to the doctor. Now new guidelines from the American Cancer Society might mean fewer Pap tests for many women.

Deaths from cervical cancer have dropped by 70% over the last 50 years. That's largely due to annual Pap tests. Now a better understanding of the natural history of cervical cancer means fewer women need the tests as often, and many don't need them at all, the ACS says.

This doesn't mean that women who aren't getting regular Pap tests don't need them. They do. A woman's best hope of surviving cervical cancer is early detection. That means she should see her doctor on a regular basis. The new guidelines mean Pap testing will be far less of a bother than it has been.

"The new guidelines will have a major impact on the number of women who are over-screened and over-treated," says Mary A. Simmonds, MD, in a news release. Simmonds is national volunteer president of the ACS.

Here's a summary of the new guidelines:

  • A young women should start getting Pap tests approximately three years after she starts having vaginal intercourse, or at age 21. (Old guidelines had women start testing at age 18).
  • Regular Pap tests should be done every year. However, newer liquid-based Pap tests need be done only once every two years.
  • At or after age 30, a woman who has had three normal test results in a row needs screening only once every two or three years. However, a doctor may suggest more frequent screening if a woman has certain other conditions that raise her risk of cervical cancer.
  • Women age 70 or older who have had three normal Pap tests and no abnormal findings in the last 10 years may choose to stop having Pap tests.
  • Most women who have had a total hysterectomy -- with removal of the cervix -- do not need Pap testing. The tests are still needed if the hysterectomy was done as a treatment for cervical cancer or precancer. Other special conditions may mean continued testing.

"Because most cervical precancers grow slowly, having a test every two to three years will find almost all cervical precancers and cancers while they can be removed or treated successfully," Simmonds says.

A new test for human papilloma virus (HPV) awaits FDA approval. If this test is approved, the ACS will add it to the new guidelines. HPV infection is linked to cervical cancer.

The new guidelines come from a panel of experts convened by the ACS. They appear in the November/December issue of CA: A Cancer Journal for Clinicians.

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