Annual Pap Tests May Not Be Necessary for All Women
According to a recent article published in The New England Journal of Medicine, the screening interval between Papanicolaou (Pap) tests may be safely extended to every 3 years, instead of every year in women who have 3 consecutive normal Pap smears.
The Pap test is a 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 death 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 papilloma 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. For 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. Currently, the frequency of screening is often dictated by the presence or absence of HPV, which is not considered in this report or the ACS guidelines.
In the recently published study, the prevalence of cervical cancer was determined in a group of over 900,000 women younger than 65 years of age. Among women ages 30-64 with at least 3 negative Pap smears, researchers estimated that the risk of cancer did not exceed “3 in 100,000” over the next 3 years. They estimated that “To avert one additional case of cancer by screening 100,000 women annually for three years rather than once three years after the last negative test, an average of 69,665 additional Papanicolaou tests and 3861 colposcopic examinations would be needed in women 30 to 44 years of age, and an average of 209,324 additional Papanicolaou tests and 11,502 colposcopic examinations in women 45 to 59 years of age.”It is important for all women to discuss her individual risk category for the development of cervical cancer with her physician, and determine the optimal screening interval for her case.
Reference: Sawaya GF, McConnell J, Kulasingam SL, et al. Risk of Cervical Cancer Associated with Extending the Interval Between Cervical-Cancer Screenings.
The New England Journal of Medicine.2003;349:1501-1509.
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