Doctor's Group: Delay Pap Tests Until 21
Changes Recommended in Schedule of Cervical Cancer Screening
WebMD News Archive
The Case Against Screening Teens
ACOG's previous guidelines called for cervical cancer screening to begin
three years after a woman becomes sexually active or by age 21, whichever
Many women become infected with sexually transmitted HPV, but most women's
bodies get rid of the infection naturally. Most women who get infected
don't develop cervical cancer, and there are other causes of cervical
But while active infection can be common in women younger than 21, cervical
cancer is remarkably rare.
"It literally occurs in about one in a million women younger than 21," Soper
Since about 85% of women who become infected will clear the HPV virus within
a few years, delaying screening until age 21 will prevent unnecessary surgical
treatment to remove suspicious lesions.
Such treatment has been linked to an increase in premature births.
"Screening for cervical cancer in adolescents only serves to increase their
anxiety and has led to overuse of follow-up procedures for something that
usually resolves on its own," ACOG's Alan G. Waxman, MD, says in a
Ob-gyn Mark H. Einstein, MD, agrees. He directs the division of gynecologic
oncology clinical research program at New York's Montefiore Medical Center.
"The vast majority of abnormalities identified though early screening are
clinically irrelevant manifestations of [transient] HPV infection," he tells
WebMD. "Early screening stigmatizes young women and subjects them to extra
testing and unnecessary treatment."
Perspective of American Cancer Society
The American Cancer Society, which was highly critical of the mammography
changes, supports the new ACOG cervical cancer guidelines.
Last June, representatives from the American Cancer Society, ACOG, and close
to 25 other health groups met to discuss cervical screening and management for
According to American Cancer Society Director of Breast and Gynecologic
Cancer Debbie Saslow, PhD, there was general agreement that for most women,
screening should begin at age 21.
Saslow says in a news release that overscreening has lead to overtreatment
of young women. But she also says that underscreening of women who should have
regular Pap tests leads to death. "Most women who die from cervical cancer have
never been screened or have not been screened in at least five years."