I find that there is considerable confusion these days about cervical cancer screening. I hear many questions about when to start Pap smear testing, how often to have a Pap smear, and at what age you can stop.
I can understand the confusion. Since I was in medical school, there have been several revisions to the recommendations based upon better understanding of cervical-cancer risks and also in light of some better screening technology.
To be sure, cervical-cancer screening is very important. The disease is deadly and preventable. More than 50 years ago, the advent of the Pap smear made death from cervical cancer (which was a leading cause of cancer death among women) a very uncommon outcome. The key is early identification of precancerous lesions and appropriate treatment.
Unlike some other screening recommendations, there seems to be a strong consensus among medical professional organizations about cervical-cancer screening. That is to say that the American Cancer Society, American College of Obstetrics and Gynecology, and U.S. Preventive Services Task Force generally agree about the answers to the questions above.
First, it is important to understand the difference between average risk and high-risk circumstances for cervical cancer.
In general, the screening guidelines for women of average risk, which will be stated here, apply to women without a known history of a previous significantly abnormal Pap smear.
Likewise, for women who have HIV infection, were exposed to a medication known as Diethylstilbestrol before birth (as a fetus), or who are immune compromised, such as when taking medicines for certain medical conditions or organ transplant, screening should be more frequent. These women should consult with their medical provider for individualized screening recommendations.
Pap smear screening should begin for all women beginning at age 21, regardless of the age of onset of sexual intercourse. This is based on evidence that the rate of cervical cancer, even among sexually active adolescents, is less than 1-2 cases per million.
Initially, Pap smear screening in the United States was recommended each year. However, this guideline has changed significantly for women at average risk. Data has recently shown that screening women older than age 30 annually would only detect one additional case of cervical cancer per 100,000 women if they have had three previous normal Pap smears.
The current consensus is that women 21 to 29 should have Pap smear testing every three years. For women 30 and older, the screening frequency is every five years provided that co-testing for human papilloma virus is included.
Generally, average risk women may discontinue Pap screening at age 65 if they have had recent normal Pap smears.
It is clear that cervical cancer screening is important and also clear that most women do not require yearly testing. Those with risk factors should consult with a doctor about individual screening recommendations. It is also important for women of all ages to discuss other preventive health recommendations with their medical provider.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Health Center in Towaoc.
