(CBS/AP) Should women get annual screenings for cervical cancer?
Not according to a new guidelines issued Wednesday by the U.S. Preventive Services Task Force. The guidelines suggest that getting a Pap test every year may do more harm than good. Instead, the task force said women should get a Pap smear once every three years.
It's not the first time the group has thrown cold water on the notion that annual cancer screening is a good idea.
Last week the group raised controversy by recommending against routine PSA tests for prostate screening, which many men over 50 get every year. And two years ago the task force suggested mammograms to screen for breast cancer were needed only every other year starting at age 50 - the American Cancer Society still recommends annual screening mammograms starting at age 40. Earlier this week, a large study found more false alarms for women getting mammograms every year instead of every other year,reported.
"The more tests that you do, the more likely you are to be faced with a false-positive test" that leads to possible harm and unnecessary biopsies, said task force member Dr. Michael LeFevre, professor of family and community medicine at the University of Missouri. "We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen" from screening.
Those benefits are substantial - cervical cancer has seen a sharp decline in the U.S., from nearly 15 cases for every 100,000 women in 1975 to fewer than 7 per 100,000 in 2008. Last year, about 12,200 new cervical cancer cases and 4,210 deaths occurred, mostly in women who weren't screened in the past five years, or were never screened.
The American Cancer Society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, could improve detection of cervical cancer. But the task force concluded the evidence "to assess the balance of benefits and harms" of that testing is insufficient.
Instead, the task force says more lives could be saved by reaching women who are not being adequately screened now.
Some critics of the guidelines suggest cost plays a role in the recommendations for les screening, a notion the task force scoffed at.
"We don't look at cost at all," task force member Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore., said. "We really are most concerned about harms," said
Got questions about the cervical cancer guidelines? Here are answers.
Q. When should screening start and end?
A. The task force recommends against screening women under 21 or older than 65. Few cervical cancer cases occur in women under 21, so the old advice to start screening three years after the age of first intercourse has been changed. HPV tests are approved only for women after age 30 because transient infections that don't pose a cancer risk are more common at younger ages.
"We should not be screening teenagers," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer." It's not helping, it's not finding any more cancers and it's creating way too many harms for them."
Q: Who else doesn't need screening?
A: Women who have had their cervix and uterus removed should not be tested. But check with your doctor - not all hysterectomies are complete and some leave the cervix.
Q: What does screening cost?
A: Paps cost $15 to $60. HPV tests run $50 to $100.
Q: Will insurance pay for HPV tests since the government task force doesn't endorse them?
A: Probably. HPV tests are included in preventive services that other federal advisers say should be covered under the Affordable Care Act, and the government continues to pay for mammograms for women who want them even if it is sooner or more often than the task force recommendations.
Q: What if I've already gotten the HPV vaccine?
A: Doctors don't know how the vaccine will affect HPV test results or how long the vaccine lasts, so women should still be screened for cervical cancer if they are within the recommended screening ages.
Q: Can I comment on the guidelines?
A: The public can comment on the guidelines here. Comments are accepted for a month before guidance is adopted.