New Guidelines Discourage Annual Pap Tests

LOS ANGELES — For generations of women, it’s been an ingrained medical ritual: Get a Pap test every year. Now, two influential groups of medical experts say that having cervical cancer screening once a year is not necessary and, in fact, should be discouraged.

Many women can wait as long as five years between screenings, the new guidelines say.

The call for screening cutbacks, released Wednesday, is based on evolving knowledge accrued over the past decade about human papillomavirus, a common sexually transmitted disease that causes most cervical cancer, and the availability of an HPV test that shows whether a woman has been infected with the most common variants of the virus.

In recent years, advice on cervical cancer screening has varied widely among medical organizations, with experts recommending screening intervals ranging from one to three years and varying according to a woman’s age and whether she is sexually active.

The fact that the two new documents are largely in agreement should reassure women and their doctors that experts have neared a consensus on what has been a controversial issue in prevention medicine, said Debbie Saslow, director of breast and gynecological cancer for the American Cancer Society, which led a consortium that was one of the groups issuing the guidelines.

“I think everyone is on the same page for the first time that I can remember,” Saslow said.

By having both a Pap smear and an HPV test — known as co-testing — women ages 30 to 65 can safely go five years between screenings if the results are negative, said Dr. Michael LeFevre, co-vice chair of the U.S. Preventive Services Task Force, which published the other set of guidelines in the Annals of Internal Medicine.

This is the first time that co-testing has been formally recommended as an alternative to Pap smears alone, although some doctors have been offering the tests in tandem for some time.

Studies show that the death rate for cervical cancer is not affected by lengthening screening intervals, LeFevre said, and the move would reduce the number of false-positive tests and unnecessary follow-up procedures.

“You can have fewer Pap smears and it is still as safe and effective,” he said. “That is the product of science and what we’ve learned about HPV.”

Both the U.S. Preventive Services Task Force and the consortium of medical groups led by the American Cancer Society continue to emphasize that Pap tests are important, however.

More than 11,000 new cases of cervical cancer are diagnosed each year in the U.S., and about 4,000 women die from the disease, largely because they didn’t get screened and their cancers were caught too late.

“If you look at cervical cancer today in the U.S., at least half of the women who get it have not been screened,” LeFevre said. “Extending out the interval to three years or five years doesn’t mean, ‘Gee, this must not be important.’ ”

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