First, let’s consider a bit of history. With the introduction of Pap smear testing, the incidence of cervical cancer has been significantly reduced in countries adopting its use. In the U.S., for example, the incidence and mortality has been decreased up to 80%.
Pap smear testing has been the standard of care for women in the U.S. for over sixty years. Many women consider the annual exam and the Pap smear synonymous. Now a marked change in the test’s recommended frequency may have many patients caught in the middle of tradition and new science.
There have been many recent modifications of the techniques and timing of Pap smear cervical cancer screening but this new proposal is, by far, the most drastic and far-reaching in my opinion.
The new cervical cancer screening recommendations are:
- Begin screening at age 21 years and screen only with cytology (Pap smear) every three years.
- Women ages 30 to 65, screen with cytology alone every three years or co-test with cytology and HPV (human papilloma virus) testing every five years.
- Women over 65 years of age with adequate screening (normal cytology for three consecutive results or two negative HPV tests within ten years before cessation of screening with the most recent screening test occurring within five years) can discontinue testing.
- Women after hysterectomy with removal of the cervix and no history of cervical cancer, or high-grade precancer require no further testing.
- Do not screen anyone younger than 21 regardless of sexual history.
What does this mean? Is the annual exam a thing of the past? No, not really. What is being stated is that annual exams should be continued, but cervical cancer screening does not need to be part of every annual exam. The annual exam without the screening portion allows for young women to benefit from counseling on healthy eating habits, risky behaviors, STDs, family planning and other issues.
Reproductive age women may use the annual exam to be counseled on family planning and other gynecologic issues.
Women in later reproductive years and perimenopausal patients may receive information regarding menopausal issues, osteoporosis prevention, and pelvic floor support problems.
All women can benefit from breast examination with breast health information, colon cancer screening, and well woman issues.
I believe that it is safe to say that women with a history of any sort of gynecologic cancer, or premalignant disease, particularly of the cervix, will fall outside of these recommendations. The guidelines work well in a perfect world, but our world is less than that. Various behaviors may place patients at higher risk for cervical problems that may become issues with these increased screening intervals. A new sexual partner or a change in general health may be examples of these issues.
As with all decisions of this sort the implementation of cervical screening intervals must be recommended and carried out at the discretion of the physician based upon the unique clinical situation and, ideally, with the participation of the patient.
Timothy B. McGuinness, D.O.
Timothy B. McGuinness, D.O. is the Chief, Division of Gynecologic Oncology at the York Hospital, Wellspan Health, York, PA. He received his medical degree from North Texas State University, Texas College of Osteopathic Medicine. Dr. McGuinness completed a rotating internship at Fort Worth Osteopathic Medical Center, Ft. Worth Texas and completed his residency in Obstetrics and Gynecology at York Hospital in York, PA. He was a fellow in Gynecologic Oncology at the Pennsylvania Hospital in Philadelphia, PA.