I'm heading to the gynecologist next month for my annual checkup and am expecting not to get my usual Pap smear. That's because the American College of Obstetricians and Gynecologists issued new recommendations today advising women not to be screened so frequently. Women like myself who are over 30 and have had three consecutive negative test results should be tested just once every three years. Those ages 21 to 30 should be tested every two years instead of every year. Those who've had an abnormal Pap smear or who've been treated for cervical precancers should continue to have annual screening.
The medical group also stated that women shouldn't start screening until age 21 because "earlier onset of screening may increase anxiety, morbidity, and expense from the test itself and overuse of follow-up procedures." (The old recommendation was to start screening by age 21 or within three years of becoming sexually active, whichever came first.) The guidelines' authors make a strong case for delaying screening. Only 0.1 percent of cervical cancer cases occur in women under 21, yet teenagers have a very high prevalence of infection with the sexually transmitted human papilloma virus. While HPV infections can cause abnormal cervical cell changes—and ultimately, cervical cancer—in teenagers, about 90 percent of the time the infection and cell changes clear up on their own within three years, according to a 2004 study published in Lancet.
The guidelines discuss an important downside of screening: the anxiety caused by an abnormal test result. "The emotional impact of labeling an adolescent with both a sexually transmitted infection and a potential precancer must be considered because adolescence is a time of heightened concern for self-image and emerging sexuality," write the guideline authors. The worry factor is one of the arguments made in favor of delaying mammography screening until age 50, which is what the United States Preventive Services Task Force this week (controversially) recommended that women consider.
I'm curious, though, as to whether gynecologists will actually implement their society's new recommendations. A study published in the current issue of Obstetrics & Gynecology found that a significant percent of women under 21 who have never had sex received a Pap smear during the previous year—in direct opposition to ACOG's previous guidelines. Nearly 35 percent of 20-year-old virgins had been screened, as had 15 percent of 18-year-olds.
While some women are clearly being overtested, others are falling through the cracks. Some 50 percent of women diagnosed with cervical cancer never had a Pap test; another 10 percent hadn't been screened within five years of diagnosis. What really works to reduce cervical cancer rates, according to the ACOG guidelines, is to increase screening in women who currently don't have it—the ultimate goal of health reform.