Pap tests needed only every 3 years

Women only need to get a Pap test once every three years to check for cervical cancer, and don’t need to be screened until age 21 - even if they’re sexually active earlier, according to new guidelines from a government-backed panel.

The statement from the United States Preventive Services Task Force, released on Wednesday, aligns closely with guidelines from three U.S. cancer groups that were also announced on Wednesday.

Once they hit 30, women also have the option of getting screened once every five years if they choose to do Pap tests together with human papillomavirus (HPV) testing every time, the committees agreed.

“The bottom line is, we strongly recommend screening,” said Dr. Virginia Moyer, chair of the USPSTF and a pediatrician at Baylor College of Medicine and Texas Children’s Hospital in Dallas.

The recommendation to test every three or five years is based on evidence that cervical cancer is relatively slow-growing, she said, so it’s very unlikely a woman would develop advanced cancer in the few years after a negative screening.

“The women who get and die of cervical cancer are the women who aren’t getting screened,” Moyer told Reuters Health. “It’s not the woman who hasn’t had a screen in a couple years that’s the problem.”

Cervical Cancer Facts

  The cervix is the lower part of the uterus or womb. It is at the top of the vagina. Cancer that starts in the cells of the cervix is called cervical cancer.

  Changes in the cells of the cervix can lead to cervical cancer. These cell changes are caused by a virus called the human papilloma virus (HPV).

  If cervical cancer occurs, there are tests to find it early when it is small and easier to treat. These tests can also find cell changes before they become cancer.

  Most deaths from cervical cancer could be stopped if more women had tests to find cervical cancer early.

Moyer’s group attracted controversy late last year when it recommended against annual prostate cancer screening in men, after concluding that the possibility the tests could invite unnecessary and potentially harmful follow-up procedures outweighed their benefits.

The USPSTF’s latest recommendations are based on a review of evidence on screening’s success at detecting pre-cancerous lesions, as well as both physical and psychological side effects of Pap and HPV tests. Its guidelines were published in the Annals of Internal Medicine.

The task force found a benefit for Pap tests every three years in women age 21 to 65, or every five years when Pap tests and HPV tests are done together, starting at 30.

Understanding Tests for Cervical Screening

There are 2 types of tests for cervical cancer screening. Both tests are done on samples of cells that a doctor, nurse, or physician assistant removes from your cervix. They gently scrape or brush the cervix with a special instrument.

  1)  The Pap test. The test can find early cell changes that are not yet cancer. If cell changes are found, they can be treated. This can prevent them from becoming cervical cancer. This test also can find cervical cancer at a stage that is easy to treat.
  2)  The HPV test. This test finds certain HPV infections that can lead to cell changes. These cell changes can progress to cervical cancer if not treated. If cell changes are found, they can be removed from the cervix. This can prevent them from becoming cervical cancer. HPV infections are very common. Most HPV infections go away by themselves and cause no symptoms or cell changes. In most cases, they do not go on to cause cancer.

These tests are good, but they are not perfect. They can sometimes report that there are precancers present when there really are not. These “false-positive” results can lead to treatments that are not needed. Pap tests have been done yearly in the past, but now we know that yearly Pap tests are not needed. In fact, yearly Pap tests can lead to harm from treatment of cell changes that would never go on to cause cancer. The new screening recommendations (shown below) keep the benefit of testing but lower the risks of unneeded treatment (called “overtreatment”).

Regular cervical cancer screening is not helpful before age 21 years. Women should start screening at age 21 years and be tested every 3 years with a Pap test. At age 30 years, HPV tests are a useful addition to Pap tests. (They are not useful for screening in younger women.) If a woman tests positive for HPV, she will need further testing to find out if she is likely to have a precancer. If she tests negative on both the Pap and HPV tests, her risk of precancer and cancer is so low that she does not need to be tested again for another 5 years.

Screen more frequently, and the possibility of women getting complications from any related procedures - such as an exam and biopsy, called a colposcopy, following an abnormal Pap - outweighs any benefit to the extra tests.

Women under 30 shouldn’t be tested for HPV because the sexually transmitted infection is common in young people and often goes away on its own, without increasing the cancer risk.

Women who are older than 65 and were screened regularly in the past are also probably in the clear, unless they’re at particularly high risk due to a history of precancerous lesions.

Until there’s more long-term data on women who’ve been vaccinated against HPV, they should continue getting normal screening, according to the report.

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