Guest Blog: A Changing Tide—Have New Pap Test Recommendations Taken Hold?

David Chelmow, MD

David Chelmow, MD

If you’ve been following women’s health news, you know that a lot’s changed recently with Pap screening. Over the last decade, health organizations including ACOG, the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF), have been reviewing research to determine how we can best prevent cervical cancer without excessive testing and unnecessary medical intervention.

The latest round of recommendations issued by each of these groups in 2012, building on guidance from ACOG in 2009, is generally consistent. All three organizations agree that for most women, cervical cancer screening should:

  • begin at age 21
  • stop after age 65 or following a hysterectomy in which the cervix has been removed
  • be performed every three years (Pap test only) OR every five years in women over 30 who’ve received negative results on a simultaneous Pap and human papillomavirus (HPV) test

The Centers for Disease Control and Prevention (CDC) recently published two studies looking at the use of Pap testing from 2000 to 2010. Much of what they found was good news and strongly suggests that doctors and patients are increasingly following the new recommendations. Fewer women younger than 21 were tested, and there was less Pap screening of women who had hysterectomy.

Unfortunately, there was also disappointing news. Many women continued to receive unnecessary Pap tests, including more than half of women younger than 21. Given the frequency of HPV infection in this age group, these young women are at significant risk for harms of testing without any expected benefit of cancer prevention. A much better strategy for prevention in this age group is HPV vaccination, but data from other sources suggest only a small portion of eligible women are receiving the full three-shot course of the vaccine. Additionally, 60% of women age 30 and older who had a hysterectomy continued to get Pap testing over this timeframe, according to CDC. Only a few of these women will need continued testing.

The studies also found that women age 22 to 30 who have never been screened increased from 6% to 9%—disturbing data considering most cervical cancer occurs in women who have never been screened or have not been screened in more than five years. Women age 30 to 64 who did not have health insurance were also less likely to be up to date with Pap screening in 2010 than in 2000.

For women to get the best protection against cervical cancer, they should get the HPV vaccine and be screened using the Pap and HPV tests according to ACOG recommendations. Let’s hope that the 2010—2020 summary finds that more women are getting screened according to the recommendations.

David Chelmow, MD, is professor and chair of the department of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond. Dr. Chelmow is a member of The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology.

A Plan to Defeat HPV

In a recent blog post titled “HPV and a Vaccine: Why We Can Beat Cervical Cancer,” William Smith, executive director of the National Coalition of STD Directors, looks in depth at the conundrum of cervical cancer in the US today. On one hand, we can now classify cervical cancer as a largely preventable disease. On the other, more than 4,000 women in the US still die from cervical cancer each year. If we are to drive these numbers down, HPV vaccination must play an essential role.

The human papillomavirus (HPV) is a known cause of cervical, vulvar, vaginal, and anal cancers in women; penile and anal cancers in men; and throat, esophageal, and other head and neck cancers in both sexes. The HPV vaccine has the potential to protect young women—and men—from many, if not all, of these cancers. Recommended for girls and women ages 9–26 and boys and men ages 11–26, HPV vaccination works best if given before any exposure to HPV or the onset of sexual activity. But despite the recommendations of ACOG and other health organizations and women’s advocates, vaccination rates have remained low.

Many parents are sensitive to discussions regarding their young daughters (and sons) and sexually transmitted infections (STI). However difficult the concept, parents would be remiss in avoiding a potentially life-saving vaccine for these reasons. HPV vaccination is just another tool in a parent’s arsenal to shield their children and family from cancer. It’s no different than routinely vaccinating infants against hepatitis B—another STI that can increase the risk of liver cancer—which has been commonplace for roughly 30 years.

As a parent, some things just make good sense. And with the benefits that it provides, HPV vaccination is clearly one of those things. Protect your children; get them vaccinated.