The Annual Pap Test Will Soon Be A Thing of the Past

The U.S. Preventive Services Task Force (USPSTF), an independent panel of private sector experts in prevention and primary care, has updated their guidance on when and how often women should receive a Pap Test for cervical cancer screening. Instead of once a year, the guidance to physicians and patients is now every three or five years depending on age and circumstances.  The guidelines were endorsed this week by the American College of Obstetricians and Gynecologists, and previously by the American Cancer Society and other medical groups.

Here’s a summary of the new guidelines, which in effect establish a new standard of practice for cervical cancer screening in this country:

  • Women should have their first screening at 21 years of age, or three years after first intercourse, which ever comes first.
  • Between age 21 and 29, the USPSTF says that once every three years is sufficient for a traditional pap smear.
  • Between age 30 and 65  women have a choice of every three years with a traditional pap test or every five years if you also have an HPV test at the same time.
  • If by age 65, you have had three consecutive, normal tests, then you can stop the screening altogether.
  • If you’ve had a hysterectomy for something other than cancer, you can also stop having Pap smears since there’s no reason to have this test when there’s no cervix.
The Pap test involves a swab of the cervix during a woman’s annual “well-woman” gynecological exam. It’s a simple, quick test that we’ve come to expect without any discussion with our physician about whether it’s necessary. But according to Dr. Michael Policar, of The University of San Francisco School of Medicine, it will soon be a thing of the past:

“Because cervical cancer is so slow to develop in both its precursor stages until it actually becomes invasive, there’s really quite a lot of time to find it. Plus the technology has improved so much that the accuracy is so much better than it used to be. So that allows us to spread the screening out…And it clearly grows so slowly that there’s no reason to check too often.

“So with just standard cervical cytology screening [the new term for the Pap test], the ability to find pre-invasive lesions is just as good, checking every three years, as it is every year or two; and now with this combination of looking for the HPV virus and the PAP at the same time, it’s even more accurate to pick up early pre-invasive lesions. When the two are negative, it is unbelievably strongly predictive that nothing is going on and won’t get started for the next five years.”

Anticipating the push-back from women who say they rather be safe than sorry, I asked Dr. Policar if these new screening recommendations are really necessary. After all, it’s a simple test performed during a routine wellness exam.

“I think this is unquestionably the right thing to do,” explained Dr. Policar, who is a member of the California Breast and Cervical Cancer Advisory Council. “If you’re screened too often with no additional benefit, it only sets you up for false positive tests. The beauty of these new guidelines is that they will prevent you from having a falsely positive test that could lead to a work-up that you don’t need. It’s all about safety and protection. It’s not about saving money. It’s about designing the intervals in such a way that you get as much as you need without getting too much.”

If you’ve have had three consecutive benign Pap tests, it’s very likely that at your next check-up, your gynecologist will suggest to you that another one isn’t necessary for at least three years. How will you feel about that?  Personally, I think the rationale behind these new guidelines make sense and we need to reconsider routine screening habits in light of new technology and knowledge.