After the recent controversy over new breast cancer screening guidelines, the recommendations issued today by the American College of Obstetricians and Gynecologists (ACOG) to do fewer Pap tests to screen for cervical cancer may seem like another blow to women's health.
But the truth is, it isn't.
The new guidelines from the ACOG recommend the following:
All women should begin receiving a Pap test at age 21. Previously, the recommendation was that women begin Pap tests at age 18.
Women ages 21 to 30 should have a Pap test every other year. The previous recommendation was for an annual screening.
Women ages 30 and over should have a Pap test (with the addition of an HPV test done at the same time as an option) every three years. Previously, the ACOG recommendation urged screenings every two to three years in this age group.
Waiting to first test women with the Pap test until they are 21 will protect so many young women from unnecessary anxiety, biopsy of their cervix and potentially harmful treatment. We now know that most of these abnormal Pap tests in young women are caused by one of the many strains of the human papillomavirus and will go away on their own without treatment in one to two years.
Furthermore, and even more important, women who are aggressively treated for an abnormal Pap test have a much greater risk of premature birth and other pregnancy complications. I have cared for many women over the years who had prior cone biopsies and other treatments to their cervix which led to difficult pregnancies.
I am worried, however, that reducing the interval for Pap tests to every two to three years, depending on a woman's age, will lead to many women falling through the cracks of health care.
The annual Pap test has been an important part of women's health for so many years, and most women view the annual Pap test with the annual visit as a rite of passage each year. In truth, so much more goes on when a woman comes in for a regular checkup, including a breast, rectal and pelvic exam, along with a check of blood pressure, heart risk factors, and so much more.
I also wonder who will manage all of the Pap test results for women? Women frequently move and change doctors and practitioners. I worry that it will be difficult to know exactly which woman has had three negative Pap tests in a row unless a woman keeps those records for herself. As I have said over and over in the past, women should manage their own health records. They should give their practitioners a self-addressed stamped envelope at each visit and keep original copies of their test results. They can then make this information available to any future practitioner.
And, of course, I wonder how insurance companies will react to this. Almost certainly they will start covering fewer Pap tests, which makes sense. However, how will they know when a woman has had three negative Pap tests in a row -- or that a woman may have had an abnormal Pap test or positive HPV test or symptoms that need closer follow up?
Until the Pap test was widely adopted in the United States in the late 1940s, cervical cancer was the number one cause of cancer death in women. After the widespread use of the Pap test, however, cervical cancer cases dropped by 70 percent. This is a huge success story.