Many women will need to get Pap smears only every five years under new national guidelines released this month.
"We're going to be able to identify a subset of women that we can put at ease," said Dr. Rosanna Gray-Swain, a obstetrician/gynecologist with BJC HealthCare. "If they have normal Pap smears and are negative for (human papillomavirus) ... they have essentially zero chance of developing cervical cancer in five years."
The recommendations from the U.S. Preventive Services Task Force reflect doctors' improved understanding of the benefits and harms of the tests. Cervical cancer, which is usually caused by certain strains of the sexually transmitted human papillomavirus, is known to be slow-growing. Annual Pap smears lead to unnecessary treatments and side effects, the task force determined.
Under the new guidelines:
• Women younger than 21 should not receive Pap smears.
• Women ages 21 to 29 should receive Pap smears every three years.
• Women 30 and older should receive Pap smears with HPV tests every five years or Pap tests alone every three years.
• Women 65 and older do not need Pap smears if their last three tests were negative.
Doctors said they anticipate questions from patients who have long believed that the Pap smear should be a yearly test.
Q. What is a Pap smear?
A. Pap smears (named for inventor George Papanicolaou) involve the scraping of cells from the cervix. The cells are examined under a microscope to identify the presence of cervical cancer in its early stages or precancerous lesions.
Q. What are the risk factors for cervical cancer?
A. The biggest risk factor is persistent, long-lasting HPV infections. Women who smoke, are HIV positive or their immune systems are otherwise compromised are at higher risk. Most healthy women can fight off the infections.
Q. Do the new recommendations apply to all women?
A. No. The guidelines do not apply to women who are at higher risk of developing cervical cancer, including those who have been diagnosed with precancerous lesions. Women whose mothers took the drug diethylstilbestrol when they were pregnant between 1940 and 1971 are also at higher risk.
Q. Why should women younger than 21 not get Pap smears, and women younger than 30 not get HPV tests even if they are sexually active?
A. Cervical cancer is exceedingly rare in teenagers, and screening poses too great a risk to future fertility to be recommended. Sexually-transmitted HPV infections usually go away on their own, especially in younger women.
Q. What are the harms of screenings?
A. The screenings can turn up false positives that lead to unnecessary treatments. Abnormal test results are followed by colposcopies (removal of tissue from the cervix with forceps) and biopsies. They also identify HPV infections or cervical lesions that would have never posed a threat to the woman's health. The removal of precancerous lesions has been linked to premature births in future pregnancies.
Q. Why should women who were vaccinated against HPV still get screened?
A. The HPV vaccine is relatively new, and long-term studies have not been completed on its effectiveness in preventing cervical cancer.
Q. Should women still get annual exams?
A. Yes. The annual exam is recommended for many health care purposes beyond the Pap smear.
Q. If I still want an annual Pap smear, will insurance companies pay for it?
A. Probably not. Insurance companies typically follow the guidelines of the task force, and would be unwilling to cover screenings deemed unnecessary.
Q. My last Pap smear or HPV test was abnormal. Can I still wait several years for the next one?
A. No. Your doctor will want to monitor your status more frequently.
Q. Do the changes to the recommended frequency of Pap smears signal a rationing of health care?
A. "This is not about taking away health care, it's about realizing that we were overtreating many women," Gray-Swain said. "Now we have guidelines to help us better identify women who are truly at risk and reassure women who are not at risk for cervical cancer."