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Group recommends fewer Pap screenings

Fri., Nov. 20, 2009

Report unconnected to recent mammogram advice

Only days after a federal panel scaled back on breast cancer screening recommendations for many women, another organization – the American College of Obstetricians and Gynecologists – has done the same for a screening credited with drastically reducing the rates of cervical cancer in the U.S.

Women of all ages should undergo Pap smears less frequently than they do now, those new guidelines say. And young women are advised not to bother until age 21.

The pullback follows the U.S. Preventive Services Task Force’s dismissal of routine breast cancer screenings for women under 50. That move triggered a storm of protest from medical groups and women, with some breast cancer specialists and Republicans accusing health officials of moving toward rationing care and services.

On Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius stressed that the task force’s guidelines amounted to advice, not policy, and that women should continue to consult with their physicians about mammograms based on their own history and needs.

But together, the two sets of revisions might give rise to a suspicion that women’s health has taken a back seat to economic pressures, cancer specialists acknowledged Thursday. The annual Pap smear is the only reason some women see a physician, and some doctors fear that, without a sense of urgency to receive that test, many women might skip preventive health care.

“I understand some people may have a cynical view of this,” said Robert Smith, the American Cancer Society’s director of cancer screening. “But we want to assure women this is not motivated to save money.”

Both sets of revisions emphasize the risks associated with annually screening millions of people who will never have breast or cervical cancer. But the creators of the cervical-screening recommendations say the two sets of guidelines are markedly different.

For starters, those recommendations reflect a broad consensus among medical groups. Most organizations agree that Pap testing does not lose its value if women are screened less frequently, said Dr. Edward Partridge, chairman of the cervical cancer screening guidelines panel for the National Comprehensive Cancer Network, an alliance of 21 cancer centers.

“Annual screening is too much,” he said. “There is no real controversy there.”

Further, the updated guidelines are based less on the potential for inaccurate results – the concern regarding mammograms for women under 50 – than on evolving knowledge about how cervical cancer develops. The disease progresses slowly, and many precancerous changes resolve on their own.

In the Pap test, cells are collected from the cervix and examined for abnormalities.

Introduced in the 1940s, the test is considered the most successful cancer screen in medical history, reducing cervical cancer deaths in the United States by more than 70 percent over the last half-century. At the same time, the test has given rise to an increased awareness about women’s sexual and reproductive health.

The most significant change in the recommended guidelines is for young women. Previously, the American College of Obstetricians and Gynecologists recommended they get an initial Pap test three years after becoming sexually active or at age 21 – whichever came first. The new recommendation calls for a first screening at age 21 regardless of when women become sexually active.

The second major change reduces screening for women age 21 to 29 who are not at increased risk for developing cervical cancer, from annually to every two years.

Also in the new document: Women age 30 or older who are at low risk should be tested every three years – instead of every two to three years – after having three normal Pap tests in a row.

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