• Women under 21 do not need to be screened, even if they are sexually active.
• Ages 21 to 29 (except those with immune problems) should have a pap smear every three years. Testing for the human papillomavirus (HPV) isn’t recommended because infections are common in this age group, but not persistent (and only persistent infections increase risk for cervical cancer).
• Ages 30 to 65 can opt for a pap smear plus a test for human papillomavirus (HPV) every five years.
• Ages 65 and older (with adequate previous screening) can discontinue screening.
• No one needs annual pap smears.
The American Cancer Society recommendation also addresses women who have had the HPV vaccine, advising that they continue routine screening because the vaccine doesn’t protect against all HPV strains associated with cancer, and the length of protection it does offer is still uncertain.
Why back away from yearly cervical testing for all? Experts say screening that often leads to more false-positive tests, overdiagnosis, and the risk of unnecessary treatment – without saving more lives.
The guidelines were released March 14.
An accompanying editorial in Annals of Internal Medicine adds some important food for thought. Approximately 50 percent of cervical cancer cases are diagnosed in women who have either never been screened, or have not been screened for five years or more. And the U.S. lags far behind Australia and the U.K. in promoting the HPV vaccine to young women at ages when it will protect them best – before they become sexually active. Only 32 percent of eligible women in the U.S. have received the full course of the vaccine. Improved efforts to protect young women, and to get all women screened regularly, would go a long way toward saving lives.
The editors also note that many women who do get screened use the annual occasion to check in with their doctors about lots of other health issues, and to get important advice. Even without the pap smears, this should continue. So when it comes to your GYN, don’t be a stranger. Annual pelvic and breast exams are still recommended.