New HPV, pap smear guidelines released

The CBS Evening News reported, “The government put out new guidelines today for screening for cervical cancer. … For decades, women have been told to get a pap smear as often as once a year.” Now, “the new recommendation calls for a test every three years for women 21 to 65” and women “ages 30 to 65 are being told they can wait five years if they get an additional test for human papilloma virus, or HPV.”

NBC Nightly News adds, “Experts have decided women need to get the test more often if they had a suspect test in the past. They need to talk to their doctors about this test and others that may require more frequently.”

The Los Angeles Times reports, “The American Cancer Society-led guidelines go slightly further, stating that co-testing” with HPV and Pap smears “is the ‘preferred’ screening strategy for women 30 to 65.

“Other authors of the document included the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology; in addition, it was endorsed by the American College of Obstetricians and Gynecologists.”

USA Today reports, based on the AP’s coverage, “Women 30 and over could stick with the every-three-years Pap and do fine, the guidelines say. But if they choose the newer Pap-plus-HPV option and the results of both tests are negative, the guidelines conclude it’s safe to wait a bit longer than previously recommended for the next cervical check. That’s because certain strains of HPV, the human papillomavirus, cause most cervical cancer, but the infection has to persist for a number of years to do its damage.”

The Boston Globe “Daily Dose” blog reports, “Women who have received the HPV vaccine still need to get Pap smears every three years, according to the recommendations, since the immunization doesn’t protect against all strains of the human papillomavirus that can cause cervical cancer.”

The blog entry also adds, “Whether doctors follow the new screening guidelines, however, remains to be seen. Most doctors haven’t curtailed their use of annual Pap smears for low-risk women in their 30s despite what the guidelines recommended, according to recent surveys conducted by the US Centers for Disease Control and Prevention.”

The New York Times “Well” blog reports, “In addition, women now are advised to begin screening at age 21 regardless of sexual history, and the task force specifically recommends against screening women younger than 21. In 2003, the advice to women was to start screening within three years of sexual activity, but no later than 21. The task force also recommends against screening women over the age of 65, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer.”

The Wall Street Journal “Health Blog” reports that a number of medical groups, including the American Cancer Society and the American Society for Clinical Pathology, have published their new consensus guidelines in CA: A Cancer Journal For Clinicians.

Discussing the problems that can be caused by testing, the NPR (3/15, Stein) “Shots” blog reports that, according to Debbie Saslow of the American Cancer Society, “more frequent testing can cause real problems.”

Saslow said that Pap smears can lead to “false alarms, which lead women to undergo procedures to make sure there’s no cancer,” and these repeated “follow-up procedures … can damage the cervix, causing serious problems” for women who want to bear children, including “preterm labor and then the birth of a premature infant or low birthweight infant.”

MedPage Today reports, “‘This is good news for women because evidence shows that an annual Pap smear is not necessary to prevent deaths from cervical cancer,’ Virginia Moyer, MD, of Baylor College of Medicine in Houston and chair of the USPSTF, said in a statement. ‘Screening every three years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests.'”

MedPage Today adds that the collaborative guidelines were also published in the American Journal of Clinical Pathology (pdf).

The US Preventive Services Task Force Task Force’s updated clinical guidelines are published in the Annals of Internal Medicine.

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