TOPICS > Science

New Guidelines Recommend Later, Less Frequent Cervical Cancer Screening

BY Lea Winerman  November 20, 2009 at 12:19 PM EST

Doctor; file photoThe advice comes from the American College of Obstetricians and Gynecologists. The group made the change after reviewing studies that found that more frequent testing didn’t catch significantly more cancers, and led to false positives and unnecessary and sometimes harmful follow-up tests and treatments.

“We really felt that the downsides of more frequent screening outweighed any benefits,” Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico who worked on the revision of the guidelines, told the Washington Post.

The new guidelines recommend that women wait to get their first Pap test until age 21; previously ACOG had recommended screening within three years of first sexual intercourse or at age 21. The group also said that women in their 20s can be screened once every two years instead of annually. Women 30 and older can wait three years between Pap tests once they’ve had three consecutive clear tests, according to the new guidelines.

The advice comes at the end of a busy week for women’s health news. On Tuesday a federal task force recommended that women wait until age 50 to get their first mammogram, and then be screened once every two years until age 74. The reasoning behind the new recommendations was similar to that behind the new cervical cancer screening recommendations — that the benefits of screening for women in their 40s was outweighed by the risk of false positives, unnecessary anxiety and unnecessary treatments.

But the recommendation kicked up a firestorm of controversy, as politicians and others aimed to make the case that the new guidelines would lead to rationing of mammograms. Health experts are also divided over the new breast cancer screening recommendations. Some patient advocacy groups, such as the National Breast Cancer Coalition, embraced the decision.

But others, such as the American Cancer Society, said that they would continue to recommend yearly mammograms for women over 40.

“I respect the task force; don’t get me wrong,” ACS Chief Medical Officer Dr. Otis Brawley said on the NewsHour. But, he added, “we happen to think that […] all women in their 40s ought to get screened annually.”

The cervical cancer screening guidelines appear to be less controversial. The American Cancer Society, among other groups, was involved in the discussions leading up to the new Pap test guidelines, and will consider them when reevaluating its own recommendations, an ACS official told the Washington Post.

Dr. Cheryl Iglesia, a member of the panel that issued the new Pap test guidelines, told the New York Times that the argument for cutting back on Pap tests is stronger than the argument for cutting back on mammograms because false positives on a Pap test can lead to greater harm. Young women are particularly likely to develop abnormalities that look precancerous in the cervix, but turn out to be benign. However, when doctors remove them, the removal procedure can damage the cervix and lead to later problems during pregnancy, such as premature birth.

Other experts told the Washington Post that the cervical cancer screening guidelines are less likely to inspire political backlash than the mammogram guidelines because cervical cancer is a rarer disease, and because the recommendations came from a private medical group rather than a government-appointed panel.

There are 11,270 new cases of cervical cancer each year in the U.S., and 4,070 deaths. But among teenage girls, there are only two cases per 1,000,000 people — a low incidence that contributed to the new recommendations.

But some doctors expressed surprise atthe new guidelines.

“My emotional response is ‘Wow, that seems dangerous,’ and yet I know the chances of an adolescent getting cervical cancer are really low,” Dr. Kevin Holcomb, a professor of clinical obstetrics and gynecology and New York-Presbyterian/Weill Cornell hospital, told the New York Times.