New York Times News Service
New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.
The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.
Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines.
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Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography – which the obstetricians’ group has staunchly opposed – because there is more potential for harm from the overuse of Pap tests.
The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.
Cervical cancer is caused by a sexually transmitted virus, human papillomavirus. Only some people who are exposed to it develop cancer; in most people, the immune system fights off the virus. If cancer does develop, it can take 10 to 20 years after exposure.
The new guidelines also say that women 30 and older who have three consecutive Pap tests that were normal, and who have no history of seriously abnormal findings on the test, can stretch the interval between screenings to three years.
Women who have a total hysterectomy (which removes the uterus and cervix) for a noncancerous condition, and who had no severe abnormalities on previous Pap tests, can quit having the tests entirely.
The guidelines also say that women can stop having Pap tests between 65 and 70 if they have three or more negative tests in a row and no abnormal test results in the last 10 years.