Change Ahead for Cervical Cancer Detection

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.

[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?
Sounds like we won't have to worry about baby boomers getting their Social
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.

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.

[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.

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)?

[clancy49]

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

[mmvale]

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

[erasmus111]

by Solarrays247 November 20, 2009 11:04 AM EST
Empire-George November 20, 2009 10:45 AM EST
Get used to rationing of care, cost-cutting measure disguised as "recommendations" which in the end, simply leads to lesser early detection, to save money....often, the most agressive types of cancer, are in the younger age ranges, and those who have family histories...of which these tests (PAP) and mamamgrams would detect.
*****************************************************************

Where have you been for the last 21 years, Georgie?


Georgie has had his head stuck up his butt for the last 21 years. The only thing he sees is his HATRED for the Liberals.

[Sandra4677]

These are RECOMMENDATIONS people - not RULES! Get your heads out of your A** and stop blaming the President for everything!!! Maybe it is the INSURANCE companies that don't want to cover these expenses, huh? Get mad at the money hungry insurance company that increases your premium and deductible every year for less and less coverage just so they can pocket more and more of your hard earned money. Insurance companies are running scared because they are being called out for thier BS and fleecing of this country. Stop blaming the President for not being able to change the economy overnight or creating jobs for every single person in America. Educate yourself on FACTS before you spout your conservative BS already!!!!!!!!!!!!!

[USMC-Mom]

Regulations will determine what insurance will pay for. Once I pay insurance every month I do not have the extra to pay for a mamo or a pap. Insurance needs to continue to do what it has been.

[USMC-Mom]

The insurance compaines will force us to go buy these guidlines, ort pay 100% out of pocket. Like most can afford it.
You don't think the presidents new health care will also do my these guide lines?

[wizcat123]

Women of America, welcome to health care rationing and the new era of Obamacare. The Government is spending over a Trillion dollars in the proposed health plan and health rationing and Government intervention has already started .... you wanted change you got it!

[USMC-Mom]

I didn't want it.

[Empire-George]

by Solarrays247 November 20, 2009 11:04 AM EST

You, and others just like you are so full of BS! I'm sick and tired, yes, sick and tired of your lies and stupidity and myopic vision...or shall I say LACK of vision!
______________

So predictable....I knew exactly how you would respond, like a good liberal....attack the insurance companies.....I was actually discussing the rationing of care and changes in recommendations by the government.....but of course, you've bought into the liberal line of "insurance companies have been rationing care" which is a bunch of nonsense, anyone can get these test through their insurance, and paid for at least once a year....but hey, who are you going to target, when the government starts rationing your care, and telling you that cancer testing is only needed when THEY say, not when you need it.

[smoknmirrors]

Actually Solarrays 247 was using "testimony against interest" to demonstrate that your argument was not restricted to criticism of the government. In any event, the "liberal" raised a couple of good arguments which you dismissed as "nonsense." Did it ever occur to you that if these tests produced results that allowed the insurance companies to claim "pre-existing conditions" the insurance companies could refuse to pay for them? Furthermore, did it ever occur to you that failure to make an insurance company aware of tests that produced a bad result could be taken as grounds by that insurance company for denial of care for ANY OTHER sickness for which treatment was sought and payment requested? That would be completely against the avowed government proposal of eliminating "pre-existing conditions" as a reason for denial of services or denial of payment for services. Who are you going to target now?