The American Congress of Obstetricians and Gynecologists (ACOG) have recently recommended new Cervical Cancer Screening Guidelines for the Pap Test

"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," says Alan G. Waxman, MD, at the University of New Mexico in Albuquerque and who headed the document developed by ACOG's Committee on Practice Bulletins-Gynecology. "A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful."

The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men.

Women should have their first cervical cancer screening at age 21.

Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents.

Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21. The immune system clears the HPV infection within one to two years among most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the vast majority of cervical dysplasias in adolescents resolve on their own without treatment.

• Women age 21-30 should have the option of having a cervical cancer screening every 2 years instead of yearly. Patients in this age group should discuss this protocol with their physician.
• Women age 30 and older who have had three consecutive negative cervical cytology
• test results may have the option to be screened once every three years.
• Studies have shown that the chances of having significant new precancerous changes on a Pap Test after 3 years is 2-3/10,000 women or 8 actual cases of cancer among 100,000 women.
• Women with certain risk factors (HIV, immunosuppressed, DES exposure in utero, history of cervical intraepithelial neoplasia (CIN) or cervical cancer) may need more frequent screening.
• Routine cervical cytology testing should be discontinued in women (regardless of age) who have had a total hysterectomy (removal of the cervix along with the uterus) for non-cancerous reasons, as long as they have no history of high-grade CIN.
• Cervical cancer screening can be discontinued at age 70 among women who have had three or more negative cytology results in a row and no abnormal test results in the past 10 years.
• Women who have been vaccinated against HPV should follow the same screening guidelines as unvaccinated women.

Do I Still Need to See My Healthcare Provider for a Yearly GYN Exam?
Many women are concerned about the new recommendations for gynecologic exams and PAP tests. It is important to realize that your yearly Gyn Exam includes more than just a Pap Test! In addition to a breast, thyroid and heart and lung exam, the pelvic exam includes looking at the vulva and vagina, as well as feeling the uterus and ovaries. The annual Gyn Exam is also every woman's preventive health screening where early education, screening and intervention can make a big difference! Your gynecologist considers everything from contraception, sexuality education, and routine screening for sexually transmitted infection to menopause, breast problems and osteoporosis screening and treatment. Even though the new cervical screening guidelines recommend less frequent Pap tests, women still need to have a yearly gynecologic exam to review their individual preventive health issues and to rule out any problems with their reproductive organs.

These exams can uncover problems such as:

• Endometriosis
• Incontinence
• Ovarian Cysts/Cancer
• Uterine Fibroids
• Sexually Transmitted Infections
• Pelvic Pain/Vaginal Pain
• Prolapse of the Uterus, Bladder or Rectum
• Sexual Dysfunction
• Precancerous Changes of the Cervix
• Pelvic Inflammatory Disease (PID)

Be sure to discuss these recommendations with your healthcare provider.

Information provided by:

The Ob/Gyn Department of The Chester County Hospital

February, 2012

Last Updated: 3/14/2012