For many decades, American women have been screened for cervical cancer annually as part of a well-woman health examination. Earlier this year, two separate health groups independently made recommendations to alter the schedule of this life-saving screening. The first group was the U.S. Preventive Services Task Force (USPSTF), and the second was a group comprised of leading cancer agencies, which included the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology. Both of these groups analyzed data and studies to come up with very similar independent guidelines. It might be added that the American Congress of Obstetrician and Gynecologists also participated peripherally with both groups and is in the process of evaluating the findings of these two groups and coming up with its own set of guidelines for its members.
The main thrust of the change is that the beginning start of screening in women has changed. In addition, the intervals of screening have been altered to occur less often over the course of a woman’s life. Most women are familiar with the PAP test, which involves removing a few cells from the cervix during a pelvic examination. The cells are placed on a slide and sent to a lab for testing. The test determines whether there is change in the cervical tissue caused by the presence of human papillomavirus or HPV for short. Such change could be a precursor to cancerous cells.
Previously it was recommended that women begin PAP tests within three years of becoming sexually active or at age 21. The newer guidelines recommend that PAP test should only begin at age 21 for most women. The second component of the new guidelines is the frequency of screening for women throughout the course of their lifetime. The annual PAP test will now be replaced with a three-year interval for women between the ages of 21 and 29. Women between the ages of 30 and 65 should also have a PAP test done every three years. However, women in this age group may elect to have PAP testing done every 5 years if they also agree to have HPV testing. Unlike a PAP test, which identifies cellular changes in the cervical cells, a HPV test is a DNA test which detects the actual presence of the virus. Only certain strains of HPV can lead to cervical cancer and these include types 16 and 18 among others.
The recommendation guidelines have also been altered for women age 65 and older. Women in this age group with low risk and adequate prior screening can stop having PAP tests. It is important to note that both groups were quick to indicate that these guidelines are for the average American woman who does not fall into a particular high-risk group. Women with a history of cervical cancer or HIV or women whose mothers took diethylstilbestrol (DES) are considered high risk for cervical cancer and should consult with their health care provider about the best screening options for them.
The change in recommendations came about for a variety of reasons. Foremost, HPV often times will clear out of a women’s system and never cause cancer. If HPV does cause a cervical change, it could take many years to develop into cancer. These new guidelines of extending the screening intervals will reduce the stress and physical complication that can occur when treating abnormal PAP results. Some literature suggests that women who are treated for precancerous lesions may suffer from higher rates of pre-term delivery.
Some health care providers fear that many women will view the new guidelines as an opportunity to forgo their annual well-woman visit. It is important to remember that an annual visit to your health care provider is essential to staying healthy. Cervical cancer screening is an important part of your gynecological visit but is by no means the only reason to see your health care provider every year. A good gynecological visit will include a complete history and physical, as well as an opportunity to discuss any concerns you might have. Women’s health care runs the gambit: from birth control to pregnancy, from breastfeeding to breast cancer, from mood swings to menopause and everything in between. Be sure to keep up with your annual visits and partner with your health care provider to stay healthy for many years to come.
Dr. Hardy is the solo physician with Atlantic Ob/Gyn with locations in Va. Beach and Chesapeake. Call 757-463-1234 or 757-548-0044 or visit www.atlanticobgyn.com.