Experts Recommend Fewer Pap Smears

In the not-so-old days, it was recommended that woman over age 21 get an annual pap smear screening for cervical cancer. That was scaled back to biannually not too long ago. But, now experts say that is too frequent and they recommend even fewer pap smears, maintaining there will be no difference in outcomes.

This will be good news to many since most, if not all, women hate getting a pap smear. The new clinical guidelines from the American College of Physicians (ACP) state that women 21 years and older with an asymptomatic, average risk for cervical cancer need a screening once every 3 years. For women over 30 with no risk factors, a pap smear should be done every 5 years provided the test is combined with a test for human papillomavirus [HPV].

The American College of Physicians is not the first doctor organization to dial back the suggested frequency of tests. Three years ago, the American Congress of Obstetricians and Gynecologists, American Cancer Society and the U.S. Preventive Services Task Force adopted recommendations of three years (and five with an HPV test).

Many doctors, however, ignore official recommendations on cervical cancer screening. In the name of caution and preventive care, they start screening woman too early, perform tests too often and continue screening older women who do not need the pap smears because their risk is extremely low. (The guidelines suggest that screening be ended for average-risk women older than 65 who have had negative tests within the past 10 years.)

Over the last few decades, the numbers of women diagnosed with cervical cancer and those that will succumb to the disease have decreased significantly – because of screenings. This year, they estimate about 7.8 cases per 100 000 women per year. That translates to about 12,900 U.S. receiving a cervical cancer diagnosis (about 4,100 of which will die from it).

So with lower rates because of screening and early detection, why are all the medical organizations recommending the broader gap between pap smears? “This is high value care,” said Robert Centor, M.D., chair of the ACP’s Board of Regents and an internist at the University of Alabama School of Medicine. Centor insisted, “Value does not only mean cost.”

The guidelines information cites cost savings as a factor in their write-up. It cannot help but make one cynical about the change. As the piece in Annals of Internal Medicine noted, “Overuse of screening contributes to higher health care costs without improving patient outcomes.” It mentioned an estimate that cervical cancer screening and follow-ups could more than $6.6 billion in 2010. Assuming that number was based on every two years as the frequency, moving to even three years, which is the main recommendation, would save more than $2 billion.

The ACP’s guidelines for cervical cancer screening are “designed to maximize the benefits and minimize the harms of testing,” said Dr. David Fleming, president of ACP.  The negative side effects from pap smears for cervical cancer screening include the initial discomfort from speculum examinations and colposcopies, pain and possibly bleeding from cervical biopsies, and more.

By Dyanne Weiss

Sources:
Annals of Internal Medicine
Medscape
Headlines and Global News
Mayo Clinic