National Guidelines Advise a Pap Smear Every 3 Years

A Gynecology Specialists note: The Virginian-Pilot ran a New York Times article by Tara Parker-Pope titled “National guidelines advise a Pap smear every 3 years.” Our GYN doctors agree with the article and for some time now have done less frequent than annual Pap smears in certain women.

The one point we at Gynecology Specialists would like to make is that although women may not need a Pap smear every year, they still need an annual Gyn exam, which includes a breast exam; a pelvic exam to detect any vulvar, cervical, uterine, or ovarian pathology like vulvar lesions, ovarian cysts, uterine fibroids, and infections; and screening for sexually transmitted infections. 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.

What the new guidelines say

The article reported that the U.S. Preventive Services Task Force issued updated guidelines recommending cervical cancer screening no more often than every three years, replacing its 2003 recommendations, with the American Cancer Society releasing similar advice the same day. Under the recommendations, women should begin Pap screening at age 21 regardless of sexual history, women younger than 21 should not be screened, women over 65 with adequate prior screening and no high-risk factors can stop, and routine HPV testing is not recommended for anyone under 30 because most women exposed to the virus eliminate it on their own. The rationale: less frequent screening achieves essentially the same reduction in cancer deaths while reducing the harm of false positives, which can lead to painful biopsies and raise the risk of pregnancy complications like preterm labor.

Amplifying information from ACOG

Following is some amplifying information sent to our GYN Clinic by the American College of Obstetricians and Gynecologists.

Why do the major medical organizations discourage annual cervical cancer screening? Cervical cancer is typically slow growing, and most cancers are found in women who have never been screened or who have not been screened in the past 5 years. Recommending less frequent screening is not new — the American Cancer Society has recommended less frequent screening for some women since 1980, and the College since 1989. The new guidelines are for women at average risk; more frequent testing may be appropriate for women at increased risk of cervical cancer, such as those who are immunocompromised or have HIV infection.

These recommendations reflect a balance between benefits and harms. Both cervical cytology and HPV DNA testing can detect cervical cancer and its precursors, but each will detect many abnormalities that will not go on to become cancer. Annual screening leads to a very small increase in cancers prevented but greatly increases unnecessary procedures and treatments. Most transient HPV infections and low-grade lesions regress within 1 to 2 years, and the small fraction that do not regress take many years, on average, to progress to cancer. The harms of over-screening include anxiety from a “positive” test, discomfort from additional procedures, bleeding from treatment, and, longer term, an increased risk of pregnancy complications such as preterm delivery in women treated with excisional procedures.

Do these new recommendations mean the end of the annual visit for women? Not at all. The decreased requirement for cervical screening frees up valuable time at the visit to address the many other important components of health care screening and evaluation. For example: adolescents and young women can benefit from counseling on healthy diet, risky behaviors, family planning, STD testing, and HPV vaccination; women of reproductive age benefit from counseling and shared decision making on family planning; perimenopausal women benefit from counseling on the menopausal transition, osteoporosis prevention, and referral for mammography and colorectal cancer screening; and women of all ages benefit from ongoing evaluation of continence and pelvic floor function.

If you are due for a Pap smear, annual GYN exam, cervical cancer screening, breast exam, or pelvic exam, please contact our GYN clinic at (757) 312-8221. Our GYN doctors are here to help you.