December 2004 · Vol. 16, No. 12Pap test every year? Not for every woman
New recommendations say a Pap test every 3 years is sufficient in some women. Solid data explain why, but old habits are hard to change.
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Fast Track
The yearly Pap test was advocated long before data suggested one interval might be better than another.
Interventions too early may lead to destruction of the immature transformation zone.
The squamous metaplasia area—the substrate for neoplasia—is diminished in most women in their 30s.
If an older woman’s sexual practices change, consider restarting screening.
When cytology is negative and HPV is positive, repeat both tests in 6 to 12 months.
I find it useful to defuse the infidelity concern by pointing out the long latency of HPV infection.
Without a yearly ‘Pap smear prompt,’ we must teach our patients why they need annual exams.
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Alan
G.
Waxman,
MD, MPHAssociate Professor, Department of Obstetrics and Gynecology
University of New Mexico
Dr. Waxman assisted in the preparation of the ACOG Practice Bulletin: Cervical Cytology Screening
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SCREENING RECOMMENDATIONS
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Begin screening approximately 3 years after coitarche, or at age 21, whichever comes first.
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Test every 1 to 2 years until age 30.
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Test every 2 to 3 years after age 30 in well-screened women whose Pap tests have been negative for CIN 2 or CIN 3.
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Consider discontinuing Pap tests after age 65 to 70 in well-screened women with no history of significant dysplasia. Evidence does not support a specific age to stop screening.
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Discontinue further Pap testing in women whose uterus and cervix have been removed and who have no history of high-grade cervical dysplasia or cancer.
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Continue annual Pap testing in women with a history of cervical cancer, in utero exposure to diethylstilbestrol (DES), or who are immunocompromised.
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Is the Pap test still necessary for every woman, every year? No, according to the latest guidelines, but old habits die hard, even for physicians.
And there is little doubt that yearly screening, though not scientifically based, has contributed much to the reduction of cervical cancer incidence and mortality in American women. Our patients and we as providers have long considered a Pap test the cornerstone of the annual gynecologic exam, as we’ve been urged to do for decades by our leading academic institutions. However, the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS) revised their guidelines last year, and no longer support yearly screening for every woman, every year.1,2 The US Preventive Services Task Force (USPSTF) revised its guidelines in accord, with the exception that it found the evidence insufficient to support screening low-risk women more often than every 3 years, at any age.3
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