Cervical Cancer Screening - Understanding the New Guidelines

The new cervical cancer screening guidelines will no doubt be confusing for many. "For years we as physicians have urged women to have annual Pap smears, and now, apparently suddenly, we have reversed course. But in truth, the new guidelines are not all that different from those that have been out for a while, and are based on good data," says Dr. Elizabeth Roth of the Women's Health Associates at Mass General. "Think of them more as a refinement of what we have been recommending for the last few years."

We have outlined the most recent guidelines below, but bear in mind that you can always discuss your particular situation with your doctor. No set of guidelines covers every situation, and certainly there are women who should continue to get more frequent Pap smears. What is important to remember is that these guidelines in no way say that women do not need Pap smears, as worldwide cervical cancer continues to claim far too many lives from a disease that is treatable in the early stages. Screening can detect pre-cancerous changes in the cervix, and can also find cervical cancer early when it is most curable (5 year survival 92%).

How often is cervical cancer diagnosed?

The estimated yearly worldwide incidence of cervical cancer is almost 500,000 cases, with 250,000 deaths every year.

In the United States, we have seen a marked decline in deaths from cervical cancer since screening with Pap smears was instituted in 1941. Cervical cancer was once a leading cause of cancer death in American women, but according to American Cancer Society data the death rate dropped 74% between 1955 and 1992 and continues to decline. Let's not reverse that trend.

In this country, even with screening programs in place, there are an estimated 11,070 new cases of cervical cancer and almost 4,000 deaths from this cancer annually. In the U.S., cervical cancer in Hispanic women occurs at a rate that is more than twice that of non-Hispanic white women. African-American women develop this malignancy about 50% more often than non-Hispanic white women.

HPV vaccine

There is hope that the relatively new Human Papillomavirus (HPV) vaccine will have a significant effect on cervical abnormalities, and thus on the development of cervical cancer. This is because HPV is the most common cause of cervical cancer. However, until more data are available, even women who have been vaccinated against HPV should continue to receive regular screening based on the recommendations below.

New guidelines

What follows is a summary of the latest guidelines released November 20, 2009 by the American College of Obstetricians and Gynecologists (ACOG) for cervical cancer screening:

* Initial Pap screening should begin at age 21. Given the low risk of cervical cancer in women under the age of 20, the new recommendations seek to avoid the anxiety, stigmatization, and cost of working up abnormal Pap smears in women under age 21, who present with an abnormal Pap smear likely due to transient HPV infection.