October 19, 2011 -- The U.S. Preventive Services Task Force announced Tuesday that healthy women between the ages of 21 to 65 should only receive a Pap smear every three years. The federal panel, which is made up of experts in prevention and primary care, also did not support regular HPV screening for most women.
The experts warned that women are currently receiving too many Pap tests, saying the excessive screenings could cause more harm than good.
Instead of continuing to overtest, the task force said it would be better to reach out to those who have never been screened.
"There are a number of women who have never been screened, and that remains a challenge," said Wanda Nicholson, one of the task force leaders and associate professor of obstetrics and gynecology at University of North Carolina at Chapel Hill School of Medicine. "We need to keep those women at the top of our priority list and brainstorm for interventions for better access."
Since the Pap smear became a regular part of women's health, deaths from cervical cancer, which was once the No. 1 cancer killer among women, have dropped dramatically.
"Cervical cancer screening is a success story, but the more testing you do, the more you run the risk of false positives, and potential harm over treatment," said Nicholson . "Cervical biopsies are associated with pain and bleeding, they can cause short-term anxiety and worry about these subsequent procedures, and those treatments can [up the] risk of poor pregnancy outcomes, including preterm or low-birth weight babies."
The new recommendations coincide with most of the task force's 2003 recommendations. One difference: The older guidelines recommended screening begin within three years of becoming sexually active, or at the age of 21, whichever comes first. Now, doctors say there is no need to begin regular screening before the age of 21, whether a woman is sexually active or not.
Most experts agree with the new guidelines.
"Cervical cancer can be slow growing and there really is no need for annual testing," said Dr. Ranit Mishori, assistant professor of family medicine at Georgetown University School of Medicine. "The hard part will be convincing patients, and particularly other doctors, that annual screens are not needed."
The task force also discouraged regular Pap screening among teenagers, which is consistent with the recommendation from the American Academy of Pediatrics. Women older than 65 and those who have had their cervix removed are also discouraged from regular screenings.
"This latest USPSTF recommendation against HPV screening and for less frequent Pap testing further endorses that more is not always better when it comes to evidence-based preventive care," said Dr. Mark Fendrick, a professor in the department of internal medicine at University of Michigan School of Public Health. "Excess testing comes at the expense of patient inconvenience [and] discomfort, unnecessary costs, as well as the mental anguish and potential side effects of false positive results."
The American Cancer Society has the same recommendations for Pap testing, but has a different view for HPV testing.
"The main difference is that, dating back to 2002, the American Cancer Society and several other organizations recommended that HPV testing, along with the Pap test, is a good option for screening women starting at age 30," said Debbie Saslow, the American Cancer Society's director of breast and gynecologic cancer, who noted that several studies show the testing provides even further insight into cancer prevention.
Two years ago, the task force made new recommendations that low-risk women receive a mammogram every two years, rather than every year. Last week, the task force stirred up debate when the panel recommended against PSA tests for prostate screenings in healthy men, which many get yearly.
The task force also recommended against testing women younger than 30 for HPV. The doctors wrote there is insufficient evidence as to whether HPV testing, alone or in combination with Pap smears, adds to cervical cancer prevention. "HPV often clears on its own and is prevalent in younger patients," said Mishori. "Not screening so frequently will give time for the infection to clear on its own, as it often does, and help ensure that too many unnecessary follow-ups and procedures will be avoided."
It is important to note that a Pap smear does not mean annual screening. Experts noted that women often confuse the two, but women still need their annual pelvic and breast examinations.
"With all these different recommendations, we run the risk of having people to start missing their Paps and make it seem like they're not important enough," said Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt in New York City. "You still need your annual exam. That means, you need your breast and pelvic exam, you just don't need the actual swabbing of the cervix every year."