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National guidelines advise a Pap smear every 3 years

Today’s Virginian-Pilot (March 15, 2012) contained an article 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.

In case you missed it, below is the Pilot article followed by information sent to us yesterday by the American College of Obstetricians and Gynecologists.

National guidelines advise a Pap smear every 3 years

By Tara Parker-Pope, The New York Times – 3/15/2012

The annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.

In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less-frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer.

The new guidelines, issued Wednesday by the U.S. Preventive Services Task Force, replace recommendations last issued in 2003 and use more decisive language to advise women to undergo screening less often. Other groups, including the American Cancer Society, released similar recommendations on Wednesday. The new guidelines were published in Annals of Internal Medicine.

“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”

Cost is not a factor in the task force recommendations. Instead, its members focus on the effectiveness of a screening test to reduce cancer deaths, balanced against the potential harms that accompany the screening. The worry about frequent Pap smear screening is that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk for pregnancy complications, like preterm labor and low-birth-weight infants.

Under the new recommendations, the task force says, women should be screened with a Pap smear no more than every three years.

In addition, women now are advised to begin screening at age 21 regardless of sexual history, and the task force specifically recommends against screening women younger than 21.

The task force also recommends against screening women over the age of 65, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Finally, the group also recommends against regular HPV screening for anyone under 30.

In 2003, the task force said it did not have enough evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus will eventually eliminate it without any intervention.

Following is some amplifying information sent to our GYN Clinic yesterday from the American College of Obstetricians and Gynecologists:

Why do the American Cancer Society, American College of Obstetricians and Gynecologists, U.S. Preventive Services Task Force, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology 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 for cervical cancer is not new. The American Cancer Society (ACS) has recommended less frequent screening for some women since 1980. The College has made similar recommendations since 1989. Note that the new guidelines from U.S. Preventive Services Task Force and ACS, American Society for Colposcopy and Cervical Pathology (ASCCP), American Society for Clinical Pathology (ASCP) are for women at average risk. More frequent testing at a GYN clinic 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.

These recommendations reflect a balance between benefits and harms. Both cervical cytology and testing for high-risk types of HPV DNA can detect cervical cancer and its precursors, but each will detect many abnormalities that will not go on to become cancer. Annual screening with cytology alone has been shown to lead to a very small increase in cancers prevented but greatly increases the number of unnecessary procedures and treatments. The prevalence of transient HPV infections and associated low-grade lesions is high, but most of these will regress within 1 to 2 years. The small fraction of lesions that do not regress will, on average, require many years to progress to cancer. Identifying and treating lesions that will likely regress on their own does not provide a benefit large enough to outweigh the harms.

These harms may include anxiety associated with a “positive” cancer screening test, potential stigmatization from the diagnosis of a sexually transmitted infection, discomfort from additional diagnostic and treatment procedures, bleeding from treatment, and, longer term, an increased risk of pregnancy complications such as preterm delivery in women previously treated with excisional procedures for precancerous lesions. While cost was explicitly not considered in the guideline development, increased testing by GYN doctors and treatment clearly has associated cost and may be an additional potential harm for some women. Extending the interval for screening strikes the most appropriate balance between benefits and harms.

As noted in the ACS/ASCCP/ASCP guidelines, no screening test has perfect sensitivity, and preventing all cervical cancer is unrealistic. Even with annual cervical cancer screening, a small risk of cancer would remain after screening.

Do these new recommendations mean the end of the annual visit for women?
The revised recommendations do not at all mean the end of the annual visit to your GYN doctor. 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.

Screening for cervical cancer is an important part of ongoing ambulatory care for women, but it is far from the only service provided by obstetrician-gynecologists and other clinicians during a well-woman exam. When screening for cervical cancer is not indicated due to interval since last screen, hysterectomy status, or age, clinicians can instead focus on other health care concerns that will be more valuable to women—instead of spending clinician and patient time on a health care service with limited benefit. For example:

Adolescents and young women can benefit from counseling on healthy diet, risky behaviors, family planning, and—if they are sexually active—testing for sexually transmitted diseases. The focus for cervical cancer for this age group should be on primary prevention through HPV vaccination.
Women of reproductive age will benefit from counseling and shared decision making on family planning, including support for consistent, effective use of their chosen method.
Women in the later reproductive years and perimenopausal women will benefit from counseling on the menopausal transition, osteoporosis prevention, and referral for mammography and colorectal cancer screening.
Both women of reproductive age and postmenopausal women benefit from ongoing evaluation of continence and pelvic floor function, which can be essential to their health and social functioning.

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If you are due for a Pap Smear, Annual GYN Exam, Cervical Cancer Screening, Breast Exam, or Pelvic Exam to screen for Vulvar Lesions, Ovarian Cysts, Uterine Fibroids, and Sexually Transmitted Infections, and live in Virginia Beach, Chesapeake, Norfolk, Portsmouth, Eastern Shore, Peninsula, Hampton Roads or North Carolina, please contact our GYN clinic at (757) 312-8221. Our GYN doctors are here to help you.

About our GYN Clinic
Our three female GYN doctors and Nurse Practitioner provide comprehensive gynecology services to women and girls of all ages in Virginia Beach, Chesapeake, Norfolk, Portsmouth, Eastern Shore, Peninsula, Hampton Roads and North Carolina.  Our health care includes Pap Smear, Annual GYN Exam, Breast Exam, Pelvic Exam, Vulvar Lesions, Ovarian Cysts, Uterine Fibroids, Sexually Transmitted Infections, Cervical Cancer Screening, and more.

Gynecology Specialists  |  516 Innovation Drive, Suite 305, Chesapeake, VA 23320  |  Ph: (757) 312-8221 Fax:(757) 312-8382  |  Medical Disclaimer
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