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Many Women May Not Need Yearly Pap Smear

Screening Every Three Years is OK for Many, Experts Say

American Cancer Society Guidelines

The American Cancer Society has called for an end to universal annual Pap smears for more than a decade, says ACS director of breast and gynecologic cancer Debbie Saslow, PhD. The group's Pap smear guidelines call for:

  • Women to begin Pap smears by the age of 21, and no later than three years after the first time they have intercourse. Women in their 20s should have annual cervical screening with regular Pap smears or should be screened at least every two years with the newer liquid-based Pap smear.
  • Beginning at age 30, low-risk women who have had three normal Pap smears in a row can opt for screening every two to three years. But women with risk factors such as DES exposure before birth or a weakened immune system should continue to be screened annually.
  • Low- and average-risk women over 30 can also limit screening to every three years if they have the conventional or liquid-based Pap smear and a smear for the human papilloma virus (HPV). HPV infection is a major risk factor for cervical cancer.
  • Women who have had a total hysterectomy and those aged 70 and older who have had three normal Pap smears in a row and no abnormal smears within a decade can usually chose to stop being smeared.

Limited Resources

Saslow says instead of continuing annual screenings of women who don't need them, limited cancer prevention resources would be better spent encouraging women who have never been screened to get a Pap smear. Half of the roughly 12,000 new cervical cancer cases diagnosed each year in the U.S. occur among women who are rarely or never screened.

But in an editorial accompanying the study, ob-gyn Sarah Feldman, MD, MPH, of Boston's Brigham and Women's Hospital expressed concern that lengthening the interval between smears could confuse many women.

"Annual screening is an easy thing to remember, but how many of us could keep track of what year we last had a certain smear," she tells WebMD. " It may be reasonable to have a Pap smear every three years, but we have to make sure that this is actually what happens."

Saslow agrees, and says it is up to physicians to do a better job of keeping track of which smears their patients need.

"This is a real problem that needs to be addressed," she says. "Dentists and veterinarians do a good job of keeping up with this kind of thing, but this is not the case with most physicians."

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