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New PAP guidelines advise women to delay testing

Posted Nov 23 2009 10:20am

As if the recent release of changes in recommendations regarding breast cancer early detection were not enough, we now have hot on it’s heels a major change in recommendations for cervical cancer screening.  The irony of these two recommendations, though from differing groups and based on review of extensive data (which certainly in the case of breast cancer is open to debate) is that they suggest changes in long standing policy regarding early detection, which have clearly had an effect on reducing the incidence and mortality from these two cancers.  The cervical cancer recommendations have some thoughtful commentary regarding using these tests too early in a young woman’s life.  These concerns are valid.  However, it is also true, that among many populations and peer groups early sexual activity is a fact of life.  Having said that, the rate of HPV is rampant  and it seems, from a public health perspective a bit perplexing, that when we have initiatives to use a new vaccine to prevent HPV, we would at that same time be suggesting taking measures that makes diagnosing HPV less likely.   Not sure ACOG has thought that angle through enough. Proper testing is important and excessive testing is not helpful.  However, the individualization of recommendations we applaud from a medical perspective, but we know that this will lead to coverage issues for patients and doctors as health insurers will adjust their payment policies to reflect these new recommendations.  Below is potpourri of comments from ACOG and various news leads on this most public story . . . . .

Women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended, according to newly revised evidence-based guidelines issued today by The American College of Obstetricians and Gynecologists (ACOG) and published in the December issue of Obstetrics & Gynecology. Most women younger than 30 should undergo cervical screening once every two years instead of annually, and those age 30 and older can be rescreened once every three years.  Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men. HPV also causes genital and anal warts, as well as oral and anal cancer…..

First Cervical Cancer Screening Delayed Until Age 21 Less Frequent Pap Tests Recommended –

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past. The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21. Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”  She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”…..

Guidelines Push Back Age for Cervical Cancer Tests –

The cervical cancer screening advice follows another panel’s controversial mammogram report, but experts say it’s a much different situation. Still, Paps are the only reason some women see a doctor. Only days after a federal panel scaled back on breast cancer screening recommendations for many women, another organization — the American College of Obstetricians and Gynecologists — has done the same for a screening credited with drastically reducing the rates of cervical cancer in the U.S. Women of all ages should undergo Pap smears less frequently than they do now, those new guidelines say. And young women are advised not to bother until age 21. The pullback follows the U.S. Preventive Services Task Force’s dismissal of routine breast cancer screenings for women younger than 50. That move triggered a storm of protest from medical groups and individual women, with some breast cancer specialists and Republicans accusing health officials of moving toward a rationing of care and services. On Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius emphasized that the task force guidelines amounted to advice, not policy, and that women should continue to consult with their physicians about mammograms based on their own histories and needs…..

Group recommends less-frequent Pap tests –,0,5

Women can delay having their first Pap test for cervical cancer until they turn 21 and many can wait longer to go back for follow-up screenings, according to new guidelines released Friday by a major medical group. The American College of Obstetrics and Gynecologists (ACOG) recommended the change after concluding that more frequent testing did not catch significantly more cancers and often resulted in girls and young women experiencing unnecessary stress, anxiety and sometimes harmful treatments because of suspicious growths that would not cause problems. “We really felt that the downsides of more frequent screening outweighed any benefits,” said Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico who led the revision of the guidelines. “More testing is not always more intelligent testing.” The change comes amid sharp controversy over new recommendations from a federal task force that women wait until age 50 before they begin having routine mammograms and that women age 50 to 74 scale back to getting the exams routinely every two years…..

Cervical cancer screening can wait till 21, group says –

Women in the United States should start cervical cancer screening at age 21 and most do not need an annual Pap smear, according to new guidelines issued on Friday that aim to reduce the risk of unnecessary treatment. The guidelines from the American College of Obstetricians and Gynecologists or ACOG now say women younger than 30 should undergo cervical cancer screening once every two years instead of an annual exam. And those aged 30 and older can be screened once every three years. The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman’s chances of carrying a child full term. “Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk,” said Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers. “Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus,” said Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, who supports the guideline changes…..

New guidelines: Pap smears should start at age 21 –

The revised guidelines released today by the American College of Obstetricians and Gynecologists also recommend that women 30 and older get screened with a so-called Pap test once every three years, instead of every two to three years. The American Cancer Society’s gynecologic cancer director said the society agreed with the advice of the doctors’ organization that additional screenings may lead to unnecessary treatment. The ob-gyn organization is the second medical group this week to recommend less-frequent cancer screenings, citing scientific data. A U.S.-backed panel said Nov. 16 that most women in their 40s shouldn’t get annual mammograms to prevent breast cancer, setting off protests from women, physicians and health advocacy groups such as the cancer society. “The data is very good that a Pap test every two years is as good as a Pap test every year,” said Alan Waxman, the lead author of the new guidelines and a professor of obstetrics and gynecology at the University of New Mexico in Albuquerque, in a telephone interview. The additional tests are inconvenient and costly, and research shows “it doesn’t make a difference in terms of lives saved,” he said…..

Screening for Cervical Cancer Should Start at 21 –

For the second time this week, a major U.S. medical panel has revised recommendations for a key test that millions of American women use to detect cancer. On Monday, it was mammograms. Today, it’s Pap tests. The American College of Obstetricians and Gynecologists says that women no longer need annual cervical cancer screenings. It also says women can now wait until they’re 21 to get their first Pap test, instead of getting one after they’ve become sexually active. “The tradition of doing a Pap test every year has not been supported by recent scientific evidence,” said Dr. Alan G. Waxman of the University of New Mexico, who headed the American College’s guideline revision…..

Annual Pap tests no longer needed, panel says –

Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that’s 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…..

Report: 20-somethings can go 2 years between Paps –


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