WebMD Medical News
Louise Chang, MD
Nov. 20, 2009 -- Less than a week after a government task force announced
controversial recommendations for breast cancer screening, a doctor's group is
recommending big changes in cervical cancer screening.
The American College of Obstetricians and Gynecologists (ACOG) now says
women should begin cervical cancer screening at age 21, rather than earlier in
And the group no longer recommends annual screening for most women.
The new breast cancer recommendations sparked heated debate within the
medical community. Even those who support delaying the onset of mammography
screening acknowledge that some breast cancers will be missed.
But experts tell WebMD the revised cervical cancer guidelines will not be as
"The new recommendations for cervical cancer screening really do not miss
any cancers," says David E. Soper, MD, who chairs ACOG's Gynecological Practice
"The data are very clear," he tells WebMD. "For women in their 20s, having
an annual Pap smear will find no more cancers than screening every two
Soper says the call for delayed and less frequent screening does not mean
Pap testing is not effective.
Screening is largely responsible for a 50% decline in cervical cancer rates
during the past three decades.
"There are still 11,000 new cases of cervical cancer and 4,000 cervical
cancer deaths in the United States each year, and most of these could be
prevented with adequate screening," Soper says.
ACOG now recommends:
Screening can be stopped in women who are 65 to 70 and have had three or
more consecutive normal test results and no abnormal test results in the past
Women who have been vaccinated against human papillomavirus (HPV) should
follow the same screening guidelines as unvaccinated women.
Even if a Pap test isn't due, doctors should let their patients know that
annual gynecologic exams may still be appropriate.
ACOG's previous guidelines called for cervical cancer screening to begin
three years after a woman becomes sexually active or by age 21, whichever
Many women become infected with sexually transmitted HPV, but most women's
bodies get rid of the infection naturally. Most women who get infected
don't develop cervical cancer, and there are other causes of cervical
But while active infection can be common in women younger than 21, cervical
cancer is remarkably rare.
"It literally occurs in about one in a million women younger than 21," Soper
Since about 85% of women who become infected will clear the HPV virus within
a few years, delaying screening until age 21 will prevent unnecessary surgical
treatment to remove suspicious lesions.
Such treatment has been linked to an increase in premature births.
"Screening for cervical cancer in adolescents only serves to increase their
anxiety and has led to overuse of follow-up procedures for something that
usually resolves on its own," ACOG's Alan G. Waxman, MD, says in a
Ob-gyn Mark H. Einstein, MD, agrees. He directs the division of gynecologic
oncology clinical research program at New York's Montefiore Medical Center.
"The vast majority of abnormalities identified though early screening are
clinically irrelevant manifestations of [transient] HPV infection," he tells
WebMD. "Early screening stigmatizes young women and subjects them to extra
testing and unnecessary treatment."
The American Cancer Society, which was highly critical of the mammography
changes, supports the new ACOG cervical cancer guidelines.
Last June, representatives from the American Cancer Society, ACOG, and close
to 25 other health groups met to discuss cervical screening and management for
According to American Cancer Society Director of Breast and Gynecologic
Cancer Debbie Saslow, PhD, there was general agreement that for most women,
screening should begin at age 21.
Saslow says in a news release that overscreening has lead to overtreatment
of young women. But she also says that underscreening of women who should have
regular Pap tests leads to death. "Most women who die from cervical cancer have
never been screened or have not been screened in at least five years."
SOURCES:American College of Obstetricians and Gynecologists Practice Bulletin,
Obstetrics and Gynecology, December 2009.David E. Soper, MD, chairman, ACOG Gynecological Practices Bulletin
Committee; professor of ob-gyn, Medical University of South Carolina,
Charleston.Mark Einstein, MD, director of clinical research and attending physician,
division of gynecologic oncology, department of obstetrics, gynecology and
women's health, Montefiore Medical Center, New York city; chairman, National
Cervical Cancer Education Campaign, Gynecologic Cancer Foundation.Leo B. Twiggs, MD, department of obstetrics and gynecology, University of
Miami Leonard M. Miller School of Medicine, Miami.News release, American College of Obstetrics and Gynecology.News release, American Cancer Society.
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