New ACOG Recommendations Call for Less Frequent Cervical Cancer Screening

November 20, 2009 — New guidelines for cervical cancer screening from the American College of Obstetricians and Gynecologists say that women should delay their first cervical cancer test until age 21 and be screened less often than older guidelines recommend, the New York Times reports. The new guidelines make additional recommendations, including that women ages 21 through 29 be screened every two years and that women ages 30 and older who have had three consecutive normal tests and who have no history of serious, abnormal findings can wait three years between screenings. In addition, women who have had a total hysterectomy for a noncancerous condition and who have had no previous abnormalities can stop having screenings entirely. Women ages 65 through 70 can stop having Pap tests if they have had three or more negative tests in a row and no abnormal test results in the last 10 years.

ACOG's older guidelines recommend that women have tests more frequently, starting within three years of first sexual intercourse and no later than age 21. The group cites the potential for harm from the unnecessary testing and potentially harmful treatment as the basis for the new recommendations. According to the Times, young women especially are prone to develop abnormalities in the cervix that disappear if left alone. When cervical cancer tests find abnormalities, physicians often remove them through procedures that can damage the cervix and lead to problems later if the woman becomes pregnant, such as premature birth and an increased risk of caesarean section (Grady, New York Times, 11/20).

The AP/Miami Herald reports that the new guidelines also better address how human papillomavirus -- which causes cervical cancer -- relates to a woman's age. Although HPV infection is high among sexually active teens and young adults, the infection is more likely to be transient in younger women. ACOG said cervical cancer in teenagers is rare, at one or two cases per one million women ages 15 to 19 (Neergaard, AP/Miami Herald, 11/20). Cervical cancer can develop 10 to 20 years after exposure to HPV.

The new recommendations do not apply to women with certain health issues that could make them more likely to develop aggressive cervical cancer, including HIV, an organ transplant or other conditions that can suppress the immune system (New York Times, 11/20).

Thomas Herzog of Columbia University, chair of an ACOG subcommittee on gynecologic cancers, said, "Overtreatment of minor abnormal Pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk." Jennifer Milosavijevic, an ob-gyn specialist at Henry Ford Health System, said that preterm delivery is a "huge problem" in the U.S., adding that she supports the new guidelines (Steenhuysen, Reuters, 11/20).

Alan Waxman, an professor of obstetrics and gynecology at the University of New Mexico who co-authored the revisions, said, "We really felt that the downsides of more frequent screening outweighed any benefits," adding, "More testing is not always more intelligent testing" (Stein, Washington Post, 11/20).

Some experts criticized the new guidelines for not being stringent enough. Carol Brown, a gynecologic oncologist and surgeon at Memorial Sloan-Kettering Cancer Center, said that the new guidelines should not be applied to all women because some girls have sex at age 12 or 13 and might be prone to cervical cancer at a younger age (New York Times, 11/20).

Some physicians said that an annual Pap test might be the only time some women see a physician and that the new guidelines might lead them to miss out on preventive care. Robert Smith, cancer screening director of the American Cancer Society, said, "I understand some people may have a cynical view of this," adding, "But we want to assure women this is not motivated to save money" (Roan, Los Angeles Times, 11/20).