Physician Brings Clarity to New Guidelines

April 9, 2012

For decades, women have been told to have their pap smear tests performed annually to screen for cervical cancer. New guidelines have now been introduced that strip away the annual test and tell women it should be done every 3 to 5 years – or not at all. But the Pap test is one part of the well woman exam, so women should keep their annual appointment.

Cervical cancer is a type of cancer that occurs in the cells of the cervix. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, cause most cases of cervical cancer. It takes 10 to 20 years for this type of cancer to develop.

Two types of tests are used for cervical cancer screening. The Pap test can find pre-cancerous cell changes and detect cervical cancer early, when it’s easier to treat. The HPV test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves, depending on the health of a person’s immune system. The HPV test may be used with a Pap test and to help doctors decide how to treat women with abnormal Pap test results.

Distancing the screenings is intended to protect women from over-testing while not putting them at risk for developing cancer that goes undetected.

“This study found that testing every three years prevented just as many cervical cancer deaths as annual testing. It also showed that the tests themselves can cause harm from false positives and their inherent risks – such as infections and infertility, emotional toll and financial costs. Infertility can result, although extremely rare, from cervical changes that occur when the precancerous cell’s are removed, when in fact, those cells that are low grade may resolve over time,” said Dr. Haskins, OB/GYN with Mercy Clinic Women’s Health in Washington. “Still, Pap tests remain a critical part of cervical cancer prevention and early detection and saves lives.” 

According to the American Cancer Society, the Pap test was first introduced in 1941 and reduced deaths from cervical cancer by about 70 percent. Cervical cancer before that time was the No. 1 cancer killer among women.

While exceptions do exist for women with certain medical histories, the new guidelines are:

  • Women younger than 21 should not be screened.
  • Women age 21 to 29 should get a pap test every three years without a separate HPV screening.
  • Women age 30 to 65 should get both a pap test and an HPV screening every three to five years.
  • Most women older than 65 do not need to be screened.
  • Women who have been vaccinated against HPV still need to be screened for cervical cancer.

"These guidelines are geared toward patients who are at low risk for cervical cancer," said Dr. Gregory Potts, also an OB/GYN with Mercy Clinic Women's Heath. "That is, they routinely have normal Pap test results, have had few sexual partners and their immune systems are uncompromised by disease or illness."

“Women under the age of 21 who are sexually active may not need a Pap test under these guidelines, but they do occasionally need an exam for infection screening to prevent future infertility,” said Dr. Haskins.

The new recommendations come from the U.S. Preventive Services Task Force, a part of the Department of Health and Human Services. The guidelines are published in the Annals of Internal Medicine and are in agreement with those of the American Cancer Society and the American Society of Clinical Pathology.

“It is important to realize that many societies and task forces put forth guidelines on occasions that can be contradictory,” said Dr. Haskins. Many OB/GYN’s follow guidelines issued by their own governing body, the American College of Obstetricians and Gynecologists, which is expected to publish its opinion in the near future. The important thing for women to know is that these are guidelines, and there are exceptions. They should talk to their doctors and go over their individual medical histories to determine whether they meet these guidelines or qualify for more frequent screenings.”

He added, “If you don’t need a Pap smear, still make plans to see your OB/GYN every year for your pelvic and breast examinations, which remain recommended by all societies. The annual exam is identical to what women are used to, although the swab of the cervix for the actual Pap Test may be taken less often.”

Drs. Haskins and Potts are two of five board-certified OB/GYNs who practice at Mercy Clinic Women’s Health, which is located in Suite 328 in the Mercy Medical Building, 851 E. Fifth St. in Washington. Their other partners are Ken Hamai M.D., Bruce Glover D.O., Christie Bleckman M.D. and women's health nurse practitioner Lisa Dickinson. Mercy Clinic Women’s Health has additional offices in Gerald and Pacific. For more information, call 636-239-1101 or visit our web site.

Mercy is the eighth largest Catholic health care system in the U.S. and serves more than 3 million people annually. Mercy includes 31 hospitals, more than 200 outpatient facilities, 38,000 co-workers and 1,500 integrated physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas.

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