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Women May Wait on Pap Smears Until 21, Group Says

November 20, 2009 at 12:00 AM EST
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Women can delay their first screening for cervical cancer until age 21, and be screened less often than recommended in the past, according to new guidelines issued Friday by the American College of Obstetricians and Gynecologists. Betty Ann Bowser reports.
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JIM LEHRER: Medical experts recommended new guidelines today on testing for cervical cancer. It was the second major change this week involving cancer screening in women.

“NewsHour” health correspondent Betty Ann Bowser has our lead story report.

WOMAN: But we discussed that issue.

PATIENT: Yes.

WOMAN: And it’s not a problem.

BETTY ANN BOWSER: For years, American women have been advised to have routine Pap smears to screen for cervical cell abnormalities and for HPV, the human papilloma virus. It causes cervical cancer and will be responsible for more than 11,000 cases and 4,000 deaths in the U.S. this year alone.

But, today, the American College of Obstetricians and Gynecologists offered new guidelines. They recommend that women wait until they are 21 years old before having their first Pap smear test, whether or not they are sexually active, that women aged 21 to 29 get tested every two years, instead of annually, and that those 30 and older with three consecutive normal Pap results should get screened every three years.

Women between 65 and 70 can quit having the tests entirely if they have had three or more consecutive negative tests and 10 years with no abnormal results.

In effect, Dr. Deborah Smith says, there was too much risk for too little gain in the old guidelines. She’s a fellow at the American College of Obstetricians and Gynecologists and a practicing gynecologist herself.

DR. DEBORAH SMITH, American College of Obstetricians and Gynecologists: … That, over the past 10 to 15 years, there’s been more aggressive treatment of pre-cancerous lesions or lesions that actually would not develop into cancer, lesions that are changes in the Pap smear, but don’t actually progress to developing cervical cancer.

And what we have found out is that, when young women were subjected to some of the treatments, it actually damaged the cervix.

BETTY ANN BOWSER: The reaction today among doctors and patients we talked to was mixed.

DOCTOR: So, I wanted to talk to you a little bit about the new Pap smear screening recommendations.

BETTY ANN BOWSER: Dr. Nancy Gaba is an obstetrician and gynecologist in Washington, D.C. She already advises patients in their ’30s to get a Pap smear every three years, as long as they have had a normal Pap and negative HPV test.

DR. NANCY GABA: Cervical cancer and its precursors are actually a very slowly progressive disease. So, by spreading out the intervals between screenings, you’re not really compromising the patient’s care, because it’s very unlikely there would be anything significantly different from one year to the next, or even two years.

BETTY ANN BOWSER: Despite the change to their routine, several patients said it makes sense.

HILARY HANSEN: And I feel very comfortable with my physician. And if she recommends that, because of my age and my medical history, that I only need a Pap smear every three years, then I’m comfortable with that.

BETTY ANN BOWSER: This is the second time in a week that a panel of experts has made major recommendations about women’s health screening for cancer. On Tuesday, a government-appointed task force advised women under 50 to scale back on routine mammograms.

DR. RICHARD BECKERMAN, obstetrician/gynecologist: I think we will be late in diagnosing cervical cancer in a number of patients that might have had it diagnosed sooner.

BETTY ANN BOWSER: And Dr. Richard Beckerman, who has been treating for more than 20 years in Washington, says he understands the science behind the new guidelines, but is worried it will drive patients away.

DR. RICHARD BECKERMAN: When we’re looking at women under 50, a lot of them and the majority of them use me as their primary care physician. So I’m the only one who is doing their breast examinations, doing their pelvic examinations, sometimes checking their lab work, listening to their heart and lungs, checking their blood pressure.

I think we’re going to lose a lot of women to follow up to certain conditions that they would have otherwise found if they were coming in on a regular basis.

BETTY ANN BOWSER: Twenty-six-year-old Ellen Rockower has her concerns.

ELLEN ROCKOWER: You know, if you catch it early on, there’s a good chance that things are going to be OK. If you don’t catch it, then this leads to more problems. So, if there’s not enough screening, then I just feel like that might lead to more problems.

BETTY ANN BOWSER: The American College of Obstetricians and Gynecologists said today there’s more to routine exams than just a Pap smear. And it urged women to continue getting regular checkups.

JIM LEHRER: We will have more on cancer screening later in the program.