CANCER GROUPS AGREE
The guidelines broadly agree with others released by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology. Those groups favor screening with both Pap and HPV tests every five years once women hit 30, but say every three years with Pap tests alone is also acceptable. Again, they recommend screening from age 21 to 65 in most cases.
In their report, released in CA: A Cancer Journal for Clinicians and other partner journals, the group’s report estimates that without screening, 31 to 33 out of every 1,000 U.S. women would be expected to get cervical cancer in their lives. With Pap tests done every three years, that falls to five to eight per 1,000.
Pelvic Exam Versus Pap Test
Many people confuse pelvic exams with Pap tests. The pelvic exam may be a part of a woman’s health care exam, and may be done even if a Pap and HPV test are not done. The pelvic exam alone will not find cervical cancer at an early stage, and cannot find abnormal cells of the cervix. Only Pap tests, or Pap plus HPV tests, can find early cervical cancers or precancers.
The relative benefit is slimmer when the tests are done more frequently, but the chance of having side effects from testing is just as high each time.
“Screening too much and too sensitively finds primarily benign infections that really would be better left unfound,” said Philip Castle, head of the American Society for Clinical Pathology Institute, who worked on those guidelines.
“Doing more than what’s evidence-based actually has potential harms for patients, and that shouldn’t be minimized.”
That includes the psychological harms of being told you have an abnormal test, he said. After that, some cervical procedures done as follow-up have been shown to increase women’s chances of having a premature baby later in life.
According to the Centers for Disease Control and Prevention, about 12,000 U.S. women get cervical cancer every year - most caused by cancerous strains of HPV.
Castle said the focus needs to be on making sure that everyone gets the basic level of screening, especially poor women who live in isolated areas.
Moyer agreed that targeting those groups is going to make the biggest difference in cutting rates of new cervical cancer cases and deaths.
“We need to get the women who have not had a Pap smear in the past five years in,” she said. “The women who aren’t getting screened at all, that’s the tragedy.”
Testing for cervical cancer : New recommendations from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology
Article first published online: 14 MAR 2012 | DOI: 10.3322/caac.21135