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    Doctor's Group: Delay Pap Tests Until 21

    Changes Recommended in Schedule of Cervical Cancer Screening

    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 occurs first.

    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 cancer.

    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 says.

    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 news release.

    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 adolescents.

    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."

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