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New cervical cancer screening guidelines released

By Saundra Young, CNN Medical Producer
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Changes to cervical cancer screening guidelines
  • American College of Obstetricians and Gynecologists recommends first Pap tests at 21
  • After age 21, women should have a Pap test every two years, instead of every year
  • Rates of cervical cancer have declined by 50 percent since the 1970s

WASHINGTON (CNN) -- The new mammogram recommendations out earlier this week caused quite an uproar. Now comes another change in screening tests for women -- this one for cervical cancer.

The American College of Obstetricians and Gynecologists (ACOG) releases new guidelines Friday, saying women don't need their first cervical cancer screening -- or Pap test -- until they're 21 years old. And, they don't need followup examinations as often as previously recommended.

According to the guidelines, women younger than 30 should be screened every two years, instead of annually. Women 30 or older can be examined once every three years.

"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," said Dr. Alan G. Waxman, who developed the document for ACOG's Committee on Practice Bulletins-Gynecology. "A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful."

The tradition of doing a Pap test every year has not been supported by recent scientific evidence.
--Dr. Alan G. Waxman

The current guidelines, from 2003, recommend that women get a Pap test three years after they begin having sexual intercourse, but no later than age 21. And that women younger than 30 have an annual exam. For women 30 or older, the recommendation was every two to three years, if they'd had three consecutive negative Pap tests.

The American Cancer Society (ACS) supports the guidelines and said it is reviewing new data and updating its own recommendations.

"There's good data since the last guidelines in 2003 that show that screening teens or before age 21 is not having an impact on reducing cervical cancer," said Debbie Saslow of the Cancer Society.

And, Saslow added, this is completely different from the new, hotly debated mammogram recommendations.

"Getting an annual Pap test is the equivalent to getting a mammogram every four months. Breast cancer on average is growing at a point where, if you get a mammogram every two years, you will miss a lot of deadly cancers that you would have caught if you're having them every year. This is not true for cervical cancer; we are detecting pre-cancers that are taking 10 to 20 years to develop into cancer."

According to the ACS, there are about 10,000 new cases of cervical cancer each year, and more than 4,000 deaths. Over half were found in women who never had a Pap test. Most cases are in women younger than 50, and rarely occur in females younger than 20.

The risk simply is not there, though the human papillomavirus (HPV), which is responsible for 70 percent or more cervical cancers, is high among sexually active teens, said Dr. David Soper of the Medical University of South Carolina.

The vast majority of those infections will resolve and not cause any significant pre-cancerous lesions, according to Soper. Females, particularly adolescents, develop immunity to HPV and can resolve the infection without treatment.

The ACS expects to release its new guidelines in late 2011.