No More Annual Pap Smears? What You Need to Know About the New Cervical Cancer Screening Guidelines

New cervical cancer screening guidelines released this week recommend that most women get a pap smear every three years instead of every year, and that women younger than 21 not get tested at all, even if they're sexually active or at risk for Human Papilloma Virus (HPV) infection.

The reasoning is that treating young women for HPV infections can cause problems that lead to infertility later on. In spite of the push to vaccinate young girls and boys against HPV, experts agree that most HPV infections clear up on their own, and the ones that don't can take as long as a decade to develop into cervical cancer, which leaves plenty of time for screening and treatment later in life.

"Screening tests can unintentionally cause significant harm," the United States Preventive Services Task Force wrote in their guidelines, which were published this week in the Annals of Internal Medicine. "False-positive test results can lead to overdiagnosis; misdiagnosis; and the potential for unnecessary diagnostic testing, procedures, and treatments and their inherent risks."

Another set of recommendations -- published jointly by The American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology -- points out that an annual check-up with your OB-GYN is still in order. "The well-woman visit has always been more than just a "Pap smear," and the decreased need for cervical screening actually constitutes a minor change to an important aspect of a woman's health care," they point out. "The decreased requirement for cervical screening frees up valuable time at the visit, which will facilitate clinicians' ability to address the many other important components of health care screening and evaluation."

Both sets of guidelines specifically say that women should not have pap smears done every year, and both underscore the fact that most of the women who die from cervical cancer have never been screened at all. While less-frequent screening will reduce problems associated with false-positives, "More frequent testing may be appropriate for women with conditions that place them at an increased risk of cervical cancer, such as immunocompromise or human immunodeficiency virus (HIV) infection," the American Cancer Society's guidelines state.

Here are some of the changes announced by both groups this week:

Women younger than 21 should not get screened for cervical cancer at all, even if they're sexually active. The previous American Cancer Society guidelines urged women to start screening within three years of becoming sexually active. Women in this age group do develop HPV infections, but now experts say that more-frequent screening can do more harm than good, Dr. Otis Webb Brawley, and oncologist and the chief medical officer of the American Cancer Society, told CNN. It can take more than a decade for a HPV infection to develop into cervical dysplasia or cancer, and "If HPV is detected, it is usually treated," he said. "However, treatment can lead to cervical incompetence and miscarriage years later. And most infections that are not treated subside within nine months without residual effects."

Women aged 21 to 29 should get a pap test -- but not a separate HPV screening -- every three years. In a pap smear, a sample of cells are taken from the cervix and checked for microscopic abnormalities; an HPV test also uses a sample of cells from the cervix, but checks specifically for strains of the human Papilloma Virus. So, why check for pre-cancerous cells but not for the virus that causes them? "The virus is highly prevalent and cytologic abnormalities are often transient," the U.S. Preventive Services Task Force guidelines say. In other words, many women may have HPV, but any physical problems caused by it either resolve on their own or grow so slowly that checking for cell changes every three years is still enough to catch cancer in its early, most-treatable stages.

Women age 30 to 65 should get both a pap test and an HPV screening every three to five years. Here is where the two sets of guidelines differ. The task force guidelines suggest running both tests every three years, but the American Cancer Society's guidelines state that pap tests should be done every three years only if HPV testing is not available or practical; women who opt for HPV testing can have pap tests done every five years instead.

Some women who are older than 65 may not need to be screened at all. Those who have not had abnormal pap test results or who have tested negative for HPV in the last 10 years can stop getting pap tests and HPV screenings done, regardless of whether they're sexually active or not.

If you've been vaccinated against HPV, you still need to be screened for cervical cancer. Because the vaccine does not protect against all of the strains of HPV that cause cervical cancer, and because long-term effects of the vaccine are still unknown, the American Cancer Society recommends that women who have been vaccinated for HPV still start screening when they're 21.

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