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To Pap or Not to Pap: What the New Cervical Cancer Screening Guidelines Mean for Women

Wednesday, March 14, 2012

New Cervical Cancer Screening Guidelines Now Available at http://ajcp.ascpjournals.org/.

 
Chicago –
The advice used to be simple, if not necessarily what women wanted to hear: A Pap smear every year. New cervical cancer screening guidelines released today are more detailed and precise, and may seem like the latest in a series of ever-changing and possibly confusing health care recommendations. The American Society for Clinical Pathology (ASCP) – a coauthor of the new guidelines and the association of pathologist physicians and medical laboratory professionals who interpret the Pap and human papillomavirus (HPV) test results – is cutting through the clutter to tell women what they need to know about these familiar tests.

Overall the guidelines say that cervical cancer screening can begin later, be performed less often and stop earlier than previously recommended. But there are, of course, exceptions.

“When new screening guidelines are released, it can be difficult for women to know exactly what to do, especially when there are new types of tests, as well as vaccines now available,” said Mark H. Stoler, MD, FASCP, past president of the ASCP and professor of pathology, cytology and gynecology at the University of Virginia Health System, Charlottesville. “As the experts in laboratory medicine, ASCP is here to help clinicians and women make sense of the new screening recommendations.”

“The guidelines strike a balance between the benefits of the life-saving screening tests and the harms of over-testing, which can include unnecessary invasive procedures and worry,” Dr. Stoler said.

Following is what women need to know about the new guidelines and recommendations for cervical cancer screening:

  • Not until age 21: Women shouldn’t get a Pap test until they’re 21 years old, even if they’ve been sexually active.
  • Every three years: Women should have a Pap test once every three years from ages 21 to 29.
  • After age 30: After 30, women should have a Pap test combined with testing for HPV every five years. HPV is a virus that can cause cervical cancer. An acceptable alternative is to continue having a Pap test alone every three years.
  • Over age 65: Women over 65 should stop getting cervical cancer screening tests altogether, as long as they’ve had at least three consecutive normal Pap tests or two negative HPV tests in the previous 10 years (the most recent in the previous five years), unless they have a history of pre-cancer. In that case, women should continue routine screening for 20 years.
  • HPV vaccination isn’t a factor: Whether or not a woman has had the HPV vaccine, she should continue to follow the above recommendations because the vaccine does not protect against all HPV strains that can cause cervical cancer.
  • After hysterectomy: If a woman has had a hysterectomy and the cervix was removed, she should not be screened at all, as long as there is no history of pre-cancer.

None of these screening recommendations applies if a woman has a history of cervical cancer, was exposed to the synthetic hormone DES when in the womb, or if her immune system is suppressed due to HIV or other conditions or medications.

“At your next appointment, make it a point to discuss cervical cancer screening with your gynecologist or primary care physician,” Dr. Stoler said. “The Pap test remains among the most effective tools ever devised to prevent cancer and cancer deaths. By adding HPV tests to the screening with the Pap test, we can provide women even better protection from cancer while performing fewer pelvic exams and tests in their lifetime.”

Leading scientists working through a collaboration of several U.S. medical societies that includes ASCP, the American Cancer Society (ACS), and the American Society for Colposcopy and Cervical Pathology (ASCCP) developed the guidelines.

The guidelines will be published in the April issue of the American Journal of Clinical Pathology. The guidelines are also being published jointly in CA: A Cancer Journal for Clinicians (ACS), and the Journal of Lower Genital Tract Disease (ASCCP).





More About ASCP

Founded in 1922 in Chicago, ASCP is a professional society with more than 100,000 member pathologists, residents, laboratory professionals, and students. ASCP provides excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals. www.ascp.org.

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