First Mammograms, Now Pap Tests

November 25, 2009 at 2:01 pm , by

3360002123_cb852b7011_tThe week before Thanksgiving was supposed to be peaceful. Let’s not talk about the fact that both your health editors were fighting bad colds, but the moment we finished dealing with the new guidelines for mammograms, the American College of Obstetrics and Gynecology (ACOG) announced that it was recommending women delay the age they start being tested for cervical cancer.

So now the annual Pap test bites the dust, too—also based on research that “screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful,” according to Alan G. Waxman, M.D., professor of obstetrics and gynecology at the University of New Mexico School of Medicine. What it means for you:

If you’re age 30 or more, you can now be tested every three years once you’ve had three negative results on consecutive tests. This isn’t a big change—starting in 2004 ACOG recommended testing every two to three years if you had negative results on three annual tests. Cervical cancer usually grows very slowly, so the interval is considered safe except for women with medical issues, such as abnormal results on previous tests. At 65 or 70, if you’ve had three negative tests in a row and no abnormal results in 10 years, you can stop completely.

If you’re 21 to 30—the group that used to get an annual test—you’re now supposed to be tested every two years, unless you have medical reasons to have them more often.

If you’re under 21, you shouldn’t get tested. A woman is supposed to wait until 21 for her first test, no matter how early she starts having intercourse. Previously, she was supposed to start about three years after her first intercourse or at 21, whichever came first. Why the change?

• invasive cervical cancer is very rare under 21
• most young women who get an HPV infection fight it off on their own, and
• treatments for cell abnormalities increase the risk of premature births.

Not all doctors agree. “For younger women, Pap smears save lives; 21 is way too late for most women in our culture,” says oncologist Elaine Schattner, MD, clinical associate professor of medicine at Weill Medical College of Cornell University in New York.

Unlike the mammogram changes, the American Cancer Society (ACS) supports the new cervical cancer guidelines and will be releasing its own revision next year. My own reading—I’m not a doctor, remember—is that the under 21 ban is the biggest question. As always, discuss what you should do for yourself (or your daughter) with your physician.

One Response to “First Mammograms, Now Pap Tests”

  1. This is an example of American doctors still struggling with evidence based medicine.
    Pap smears are of no benefit in women under 25 and Finnish & Dutch doctors say 30. Given the Finns have the lowest rates of cervical cancer in the world and send the fewest women for biopsies, I think they have a better idea than many other doctors.
    Your doctors have been exposing you to high risks – women in the States are over-examined, over-screened and over-treated – the excess is awful and terribly harmful to your health and lives.
    You have huge rates of excessive colposcopy worth about a billion dollars a year to doctors, not to mention other procedures and a massive 600,000 hysterectomies every year – a frightening figure.
    The lack of evidence based medical thinking in your country has turned womanhood into a disease.
    The annual gyn exam is NOT evidence based – in fact, the evidence says the routine pelvic exam is of poor to low clinical value and exposes you to risk, (more unnecessary procedures even surgery) the routine breast exam – does not bring down the death rate, but causes unnecessary biopsies and some believe they are a risk factor for cancer.
    Pap smears require informed consent by law, but there is very little honest and clear information. Pap smears are of no value in young women and cause over-treatment and problems – infertility, miscarriages, problems in pregnancy, pre-term labour and premature babies and psychological issues. Young women have a tiny risk from cancer, but a very high risk of false positives and over-treatment.
    Only 0.65% of all women benefit from smears while 99.35% derive no benefit (incl the 0.35% who get false negatives) – the unreliability of the test means annual screening will send 95% of you at some point for colposcopy and usually some sort of biopsy – and your doctors have a reputation for aggressive over-treatment. Two yearly – 77%
    Three yearly – 65%
    Even 5 yearly sends 30%-55% of women – the best you’ll do with this unreliable test.
    All of this for a risk of 1% – no screening at all – 1% of women would get this cancer. With screening and especially with irresponsible screening, most healthy women are dragged into this unpleasant business.
    As a low risk woman, I have always declined screening – the risks are just too high.
    Please do your reading and make an informed decision. I know many of your women who’ve been harmed by doctors overusing this test and doing unnecessary exams with no evidence base.
    Protect your healthy bodies from harm – the Violet to Blue website contains some great information that seeks to inform women. My statistics are taken from Richard DeMay’s (American pathologist) article, “Should we abandon pap smear testing” – available on line.
    Don’t over-react to the very small risk from this cancer (and low risk women have a near zero risk)- Dr Angela Raffle, UK screening expert tells us, “1000 women need regular screening for 35 years to save ONE woman from cervical cancer” – published in the BMJ in 2003.
    Virgins and women in lifetime mutually monogamous relationships do not benefit from smears and should be very careful with any testing. Also, women who’ve had complete hysterectomies for non-cancerous conditions.
    Mammograms – lots of risk – before you agree to them, have a look at a rare unbiased summary produced by the Nordic Cochrane Institute, “The risks and benefits of mammograms” – at their website. The NCI produced this brochure as they were deeply concerned at the incomplete and misleading information being given to women.
    More than ever, women need to make informed decision about their healthcare.
    Less is always more with screening and sometimes, none at all is even better.
    It is never right or wrong to screen, your informed decision is the right decision.