Less frequent pap tests safe for most women, ob/gyn group says

For women aged 30 and older, the Pap test, as it is called, should be done along with a test for human papillomavirus (HPV) every five years, according to new guidelines released by the organization Monday.

"The yearly Pap test was an arbitrary decision when it was recommended years ago," said Dr. David Chelmow, chairman of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond.

This change should reassure women, because it is scientifically based on the results of several studies, said Chelmow, who led the development of the guidelines.

The college recommended women aged 30 to 65 get an HPV test along with the Pap test because "we know HPV is the cause of most cervical cancer," Chelmow said.

If both tests are normal, no further tests are needed for five years. If the HPV test is positive, more frequent testing is needed. And if both the HPV and Pap test are positive, further testing and treatment will be done, he said.

The guidelines, published online Oct. 22 and in the November print issue of the journal Obstetrics & Gynecology, are in line with recommendations released in March by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and other medical groups.

Routine Pap testing has cut the rate of cervical cancer by more than 50 percent in the United States. "Women who develop cervical cancer are mostly those who have never been screened," Chelmow said.

According to the American Cancer Society, more than 12,000 women will be diagnosed with cervical cancer in 2012, and more than 4,000 will die from it.

For the Pap test, cells scraped from the cervix are examined under a microscope for signs of cancer or precancerous abnormalities.

Cervical cancer is caused by some types of HPV, a common sexually transmitted infection. Most women with healthy immune systems can eliminate HPV infections, but a small number with persistent HPV infection will develop cervical abnormalities that lead to cancer, Chelmow explained.

According to the new guidelines:

• Women aged 30 to 65 with normal Pap and HPV tests need screening only every five years. If only a Pap test is available, it is needed every three years.
• Women aged 21 to 29 should be screened every three years instead of every two years.
• Women under 21 do not need screening because invasive cervical cancer is rare in this age group.
• Women 65 and older don't need screening if they have no history of cervical cancer and have had three consecutive normal Pap tests or two consecutive Pap and HPV tests over a 10-year period with the latest test done within the past five years.
• Women of any age who have had a total hysterectomy, which includes removal of the cervix, and have no history of cervical cancer do not need regular screening.
• HPV-vaccinated women should follow the same screening guidelines as unvaccinated women.
• Some women need more frequent screening. They include women who have had cervical cancer, are HIV-positive, have compromised immune systems or were exposed to the drug diethylstilbestrol in the womb.

The new guidelines were designed to strike a balance between protecting women from cervical cancer while avoiding unnecessary tests that could lead to complications, Chelmow said.

Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital in New York City, said women shouldn't interpret the recommendation for less frequent Pap tests to mean they don't need an annual "well woman" visit.

"We really need to highlight to the women we treat that just because we recommend a Pap test every three to five years doesn't mean you only see your doctor every three to five years," she said.

The annual exam addresses other health and wellness concerns, she noted.

Also, women should review these recommended changes with their doctor to see how they apply to them, she said. "Women really need to discuss with their doctor how these guidelines apply specifically to them and their health history," she said.

More information: For more information on PAP and HPV tests, visit the U.S. National Cancer Institute.

Journal reference: Obstetrics & Gynecology

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