Cervical Cancer News Information Blog | HPV Vaccines, The Pap Smear Test, and the Latest Cervical Cancer Research

Washington, D.C.

A national physician’s organization has revised its cervical cancer screening guidelines, saying that women in their 20s can have a Pap smear every two years, instead of every year.

The statements follow closely after the start of an ongoing discussion on regular mammograms, stemming from debate on when women should start having the procedure — in their 40s or 50s.

The proximity of the two items has prompted some to worry about a perceived drift toward future health care rationing, fueled by debate over health care reform.

But the American College of Obstetricians and Gynecologists, which released the new cervical cancer guidelines last week, said women younger than 21 are at very low risk of cancer — and screening them may lead to “unnecessary and harmful evaluation and treatment.”

The organization said women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended. The new guidelines say most women younger than 30 should undergo cervical screening once every two years instead of annually.

Those age 30 and older can be rescreened once every three years, according to an ACOG news release.

Abilene physician Peter Norton said that in some ways, issues behind the new guidelines stretch back to the 1940s. In 1945, the test gained the support of the American Cancer Society.

Cervical cancer is a slow-growing cancer caused by certain strains of the human papillomavirus (HPV), a common sexually transmitted disease among women and men that also causes genital and anal warts, as well as oral and anal cancer.

“It’s the first time you really know the cause of a cancer — that it’s a virus,” Norton said.

The ability to discover abnormalities earlier, and to find premalignant cells early on, sounds “very logical and very good,” he said.

But in the last 10 years, it’s become known that not all of the infections progress to a cancerous state. So a certain percentage of women may not need to be treated at all, since their own immune systems are able to handle the infection.

“When you couple that with the fact that the cervix is important to maintaining a pregnancy to term, anything that we do to treat premalignant cells might damage the cervix to a certain extent,” he said. “So that becomes an issue.”

All such things considered, Norton worried that because of the suggested guidelines, some patients would be left untreated, leaving them open “to expose other people to HPV.”

“That’s not isolating the disease the way infectious diseases have been traditionally isolated,” he said.

Sexual activity — skin to skin contact, not necessarily intercourse — is what spreads HPV, Norton said.

“We know that there are certain groups of women who probably do not need Pap smears,” he said. “I feel age 21 was used because they feel most girls, probably 60 to 80 percent, are going to be sexually active by the time they’re 18 or 19 years old.”

But that number isn’t accurate for everyone, he said.

Women should start receiving Pap smears three years after the initiation of intercourse, he said.

And for some women, waiting as much as three years between screenings might be “too long,” he said.

Cervical cancer rates have fallen more than 50 percent in the past 30 years in the United States because of the widespread use of the Pap test, according to ACOG, which said in its statement that the majority of deaths from cervical cancer in the U.S. are among women who are screened infrequently or not at all.

Vaccination against HPV is expected to cut cervical cancer rates in the future, but for now, ACOG’s guidelines say vaccinated women should follow the same Pap guidelines as those who are unvaccinated.

Norton dubbed it “interesting” that the guidelines were coming out around the time of the national health debate, though ACOG has said that its similarly timed release is simply coincidental.

Helen Teague, coordinator for women’s health/community initiatives with Hendrick Health System’s Vera West Women’s Center, said she worried that both the breast cancer debate and the revised screening guidelines might herald “the beginnings of the rationing of health care.”

Teague said cervical cancer is preventable with screening and she touted the procedure as safe.

“My question in this whole thing, not only with the mammogram suggestion and now this, is why is it advisable to keep women, in this case, young women, in the dark about their health?” she said. “If we have the technology, why aren’t we using it? Why would we delay in using it?”

An initial cervical cancer screening sets an important baseline for future screenings, she said.

“Most of the folks who make these decisions do not see the faces of those these decisions impact,” she said.

Nationally, some sought to connect the mammogram recommendations to the health-care overhaul, contending that such findings are the way that medical rationing starts.

Under the pending legislation, “nothing would prohibit the federal government from deciding if tests, treatments and procedures are too expensive, and therefore, unnecessary,” Sens. Jon Kyl of Arizona, the Republican Whip, and Tom Coburn of Oklahoma, a physician, said in a joint statement.