The recommendations for the new guidelines were composed from four panels: a gynecologic cancer advisory group; a work group on interval, older women and hysterectomy; a when to start screening work group; and a work group on technologies who all reviewed and deliberated medical evidence regarding the screening for cervical cancer.
The Papanicolaou (Pap) smear is an annual screening procedure during which a physician scrapes cells from the cervix for examination under a microscope. The results of the Pap smear are then classified into five categories: negative or within normal limits (normal); atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesions (abnormal); high-grade squamous intraepithelial lesions (abnormal); or carcinoma (cancer). Cervical cancer is typically very slow growing and deaths rates from this disease have been reduced dramatically from screening procedures. There are some factors that place women at high risk for developing cervical cancer, such as the human papillomas virus (HPV). Since cervical cancer is slow growing, researchers have deliberated over the necessity of annual pap smears.
The American Cancer Society’s new guidelines state that cervical screening for a woman should begin three years after the beginning of vaginal intercourse, but not later than 21 years of age. If a physician uses regular Pap tests, screening should continue annually to the age of 30 years. If a liquid-based Pap test is used, screening can be done every 2 years, provided that results are normal. Once a woman reaches 30 years of age and has had 3 consecutive “normal” Pap tests, screening can be done every 2 to 3 years. However, women who are at an increased risk for developing cervical cancer may have screening done more frequently. Women who obtain Pap test results that are not normal, subsequent tests and follow-up are individualized and need to be discussed with her physician. Furthermore, women who are 70 years or older and have had 3 previous normal Pap test results and no abnormal results in the past 10 years may consider stopping screening for cervical cancer altogether.
It is important for all women to undergo appropriate screening measures for cervical cancer. Patients may wish to discuss the risks and benefits of these guidelines with their physician and individualize a screening plan to provide optimal benefits for them.
Reference: Saslow D, Runowica C, Solomon D, et al. American cancer society guideline for the early detection of cervical neoplasia and cancer.
CA: A Cancer Journal for Clinicians. 2002;52:342-362.
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