Question: What do the new recommendations say about Pap smear/cervical cancer screening?
Answer: Previously, the Pap smear, a cervical cancer screening test, was recommended every 1-3 years. New recommendations from the U.S. Preventive Services Task Force state that women who are under the age of 21 do not need a Pap smear at all, regardless of sexual history; healthy women who are 21 to 29 years old only need a Pap smear once every three years; and healthy women between the ages of 30 and 65 need a Pap smear only once every five years if they combine it with a test for human papillomavirus, or HPV (a sexually transmitted infection and the leading cause of cervical cancer). The guidelines are completely in line with the recommendations of the American Cancer Society and other medical organizations.
Q: In healthy women who've never had an abnormal pap smear, why can they now have this done once every 3-5 years?
A: There are three reasons. The first is that cervical cancer develops very slowly, over a period of 7-20 years. A cancer is unlikely to be missed between 3-5 year screenings in a woman whose previous Pap smear results were normal. Second, Pap smear technology is much better now than a decade ago, and therefore, much more sensitive in its ability to detect cervical abnormalities. Addition of the HPV co-test to the Pap smear has further increased the sensitivity of cervical cancer screening. So with better, more sensitive screening tests, it is safe for healthy women to undergo fewer tests overall without compromising their health.
Q: How effective a diagnostic tool has the Pap smear test been historically?
A: The Pap smear is the single most effective and successful cancer screening test in history, and many other screening tests used in medicine are modeled after it. Prior to the introduction of the Pap test in the 1940s, cervical cancer was one of the leading causes of cancer death for women in the United States. But after cervical cancer screening was initiated using the Pap, cervical cancer incidence was reduced by 70 percent and deaths from cervical cancer by 90 percent. But we have recently learned that, like colon cancer screening with colonoscopy (which is typically performed every 5-10 years), the Pap smear does not need to be performed annually to be effective.
Q: Is there a concern that women may develop cervical cancer and have it go unnoticed/untreated in between regular exams?
A: The leading cause of cervical cancer is infection with HPV. Most women who are exposed to HPV will not develop cervical cancer, but a percentage will develop precancerous changes or invasive cancer. Because the interval between HPV infection and development of cervical cancer may take years, it is unlikely that a healthy woman with a previously normal Pap smear will develop a cancer between screenings. However, if a woman develops persistent irregular vaginal bleeding, especially after sexual intercourse, or unexplained vaginal discharge or pelvic pain between gynecology visits, she should consult with her physician sooner, as these may be signs of a cervical abnormality or female cancer.
Q: Does this mean women now don't have to go for yearly GYN exams?
A: Screening for cervical cancer with the Pap smear is very important but is only one aspect of women's health. Although the new guidelines recommend Pap smear screening once every 3-5 years in healthy females, women are still encouraged to see their gynecologist or primary care provider on an annual basis for breast care, pelvic exams and general and women's health issues.
Q: Why are the new recommendations a good thing for women's health?
A: The new guidelines represent a significant step forward for women's health. Major breakthroughs in our understanding of HPV and its role in cervical cancer as well as advances in Pap smear technology have revolutionized the approach to cervical cancer screening. Fewer Pap smears performed in conjunction with HPV testing will detect the same number of cancers as before but with the added benefit of decreased health care costs for women and reduction in the risk of false positive results, which may lead to unnecessary and painful biopsies, cervical procedures, and an increased risk of infection, infertility, risks to future pregnancies and stress for women. The best protection against development of cervical cancer is to continue Pap smear screening according to the new guidelines and to prevent HPV infection through safe sex practices and HPV vaccination. But not all women will be candidates for screening every 3-5 years, so I encourage women to consult with their physicians regarding these new guidelines to determine what screening interval will be best for them.