New guidelines for cervical cancer screenings

Women should delay their first cervical cancer screening until age 21 and can be screened less frequently.

So say new guidelines from the American College of Obstetricians and Gynecologists.

Most women younger than 30 should be screened once every two years, and those older than 30 should be screened once every three years.

Cervical cancer rates have fallen more than 50 percent during the past 30 years due to widespread use of the Pap test, which screens for cancer.

The American Cancer Society estimates there will be 11,270 new cases of cervical cancer and 4,070 deaths from it this year. The majority of deaths from cervical cancer are among women who are screened infrequently or not at all.

Cervical cancer is a slow-growing cancer caused by certain strains of the human papillomavirus, an extremely common sexually transmitted disease among women and men. It also causes genital and anal warts and oral and anal cancer.

Despite the furor about recommended changes in breast cancer screening, there is little expected controversy about the change in pap tests.

“The tradition of doing a Pap test every year has not been supported by recent scientific evidence,” said Alan G. Waxman at the University of New Mexico in Albuquerque.

“A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful,” he said.

Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents, which can have economic, emotional and future childbearing implications. ACOG previously recommended that cervical screening begin three years after first sexual intercourse or by age 21, whichever occurred first.

Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21.

The immune system clears the HPV infection within one to two years among most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the large majority of cervical dysplasias in adolescents resolve on their own without treatment.

A significant increase in premature births has recently been documented among women who have been treated by excising the dysplasias.

“Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix,”  Waxman. “Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own.”