Change Ahead for Cervical Cancer Detection

Women in their 20s Should Get Pap Smear Every Two Years, Not Annually, OB/GYN Organization Says

(CBS/ AP)  Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that is enough to catch slow-growing cervical cancer.

The change by the American College of Obstetricians and Gynecologists comes amid a completely separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics&Gynecology.

The guidelines also say:

- Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.

- Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.

- Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.

These new guidelines might actually be more of a surprise to patients than to any gynecologist, especially since the changes have been evolving for over a decade. ACOG also added that cervical cancer rates have now fallen by over 50 percent in the past 30 years due to extensive pap testing, but these guidelines are actually closer to what The American Cancer Society recommends as well, CBS News medical correspondent Dr. Jennifer Ashton reports.

Paps can spot pre-cancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades.

Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare - one or two cases per million 15- to 19-year-olds - while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.

[Ichabod09]

Lemmie see since there is both a scruuwer and a scruuwee with both being capable of transmitting HPV, shouldn't both be immunized for HPV?

[sean70x]

Objective medical science requires regular testing for cancer. Who needs Nancy Snyderman's baboon babble? Women should avoid unethical doctors who want patients with aggressive cancer for extreme billing to insurance companies.

[mammographer]

The change in recommendations in womens health represent two distinctly different processes. The change in recommendations for mammogram screening came from the USPSTF. The USPSTF is a federal advisory panel of public health experts, none of which are directly involved in breast cancer care. The USPSTF changed their previous recommendation because of the harm of anxiety generated by false-positive exams, overdiagnosis, and overtreatment. The ACOG is a society comprised mainly of practicing OB/Gyn specialists. This is the group engaged in diagnosis and treatment of cervical cancer. The ACOG changed their recommendations based on new data indicating a significant increase in preterm deliveries associated with treatment of cervical dysplasia. Preterm deliveries are associated with infant morbidity and mortality. The official paper stating the evidence has not yet been released to the press by the ACOG. The change in the ACOG recommendation is based on the risk vs benefit assessment, where the risk is increased infant mortality. The USPSTF recommendation is based on the risk vs benefit ratio where the risk is the anxiety of the patient. The USPSTF officially denies that cost was a consideration, but does note in their published papers that the economic cost is evident from the estimate that 1904 women would have to be screened to save one life (search for the word proxy in their papers). The members of ACOG stand to lose income by their new recommendations.

[mpc966011]

Wow...What was that whole "One Less" campaign all about? Took my 11yr old to doc in August and he lectured me for a very long time when I refused the vaccine. So, no paps, no mammograms, but by golly anyone want an abortion?<br />Sounds like we won't have to worry about baby boomers getting their Social<br />Security, most of them will have died from cancer. Glad someone found an answer to THAT problem! NO TO ANY HEALTH CARE PROGRAM RUN BY THIS GOV'T

[Ezzy666]

The new guidelines do make sense. I've had HPV and my doctor monitored it for four years before deciding to do anything about it. This is quite common. I could've easily gone to the doctor every 2 years and gotten the same treatment. <br /> <br />I called my doctor to cancel my upcoming annual visit, since my last four exams were normal. She said that if I wanted to get a renewal for my birth conrol I still had to go every year. So I guess we will still have to put our feet in stirrups every year, regardless of the new guidelines.

[Solarrays247]

I'm very happy for you, Ezzy666! I wish you continued health! However, every woman is different, and after losing friends back in the 1980's to both cervical and breast cancer....I believe in utilizing common sense, and looking at each woman and her unique situation, rather than making blanket statements that will only continue to erode health coverage for all. :=)

[enwr77]

Healthcare reform is really a bailout for the insurance companies. Now I see why some Americans do not want the government involved in their healthcare. They have given the insurance companies control over our lives. Since the FDA is no longer in their pockets, others are being paid to produce and perform studies with outcomes that will relieve them from paying our healthcare bills. This is will have the affect same as refusing to insure us. They will receive mandated premiums and reprieve from paying justified by these bogus studies. Now the American College of Obstetricians and Gynecologist is in the back pockets of the insurance companies and will lose their credibility as the FDA did. <br /> <br />It is especially interesting that the studies are discriminating against women. This study only makes since if no women bare children before 21 years old and we have a nation with no teenage pregnancies. The dummying down of America has spread into the medical profession. The insurance companies, their paid cronies and the government are waging WAR on women. Where is the National Organization for Women (NOW)?

[Solarrays247]

"The insurance companies, their paid cronies and the government are waging WAR on women. Where is the National Organization for Women (NOW)?"<br />~~enwr77 November 20, 2009 6:34 PM EST<br />********************************************************<br /><br />Great question! <br /><br />I happened to be at our local "Breast Center" this afternoon for another mammogram and ultrasound because of the results of my annual mammogram a week ago. I was struck by the number of young women in their thirties who were there for biopsies and ultrasounds! What will happen to these young women if the new guide lines are implemented...not only for breast cancer, but also for early detection of cervical cancer? <br /><br />This is a travesty! We NEED someone to step up to the plate and speak for all women! One of our local doctors was on a radio talk show this morning, and he was so upset at these recent findings. He said he is going to challenge these recent findings because they are not in keeping with what he is experiencing in his day to day practice. We need more doctors, and health care professionals like him...with enough guts to challenge these findings.

[apachekid]

After months of scheming Obama, Pelosi &#38; Reid have managed to include FREE Prostrate Tests For Women and FREE Pap Tests for Men, whether they need them or not. FREE Mammograms are being considered for Men of all ages. Thanks to Health and Human Services Secretary Kathleen Sebelius for her suggestions. Go Figure?

[clancy49]

Quick question: Are male exams going to be attacked soon? I mean is a prostrate exam really necessary?

[Solarrays247]

clancy49 November 20, 2009 2:54 PM EST<br /> Quick question: Are male exams going to be attacked soon? I mean is a prostrate exam really necessary?<br />**************************************************<br /><br />Interesting question, clancy49. Betcha' there would be an outrage if Viagra is deemed as not viable to saving lives, therefore, it will no longer be covered by the health insurance industry! ;=)

[mmvale]

This healthcare bill is a gift to the unions. It will do to healthcare what it has done to our educational system.

[Ms_enza]

and you are clearly a product of that education system.

[Ms_enza]

How many men does it take to clean a toilet? None, it's women's work. <br /> <br />Viagra and PSA tests covered. <br />Pap smears and mammograhy... nix. <br /> <br />Why?? 'Cause a boob with a lump is still a boob.