According to recent studies, many women are receiving unnecessary Pap tests, or smears, to screen for cervical cancer, while others are not receiving the appropriate tests. The guidelines for how often women should receive Pap tests were recently changed. Previously, physicians typically administered Pap tests to women 3 years after they became sexually active, or when they turned 21. After that, women were advised to receive a Pap test once every one or two years.

In March 2012, physicians’ groups released new Pap test guidelines. These recommend that most women do not need a Pap test before age 21, and that between ages 21 and 65, women should typically be tested once every 3 years. However, some women ages 30 to 65 may receive a Pap test in intervals of 5 years, as long as they are being tested for the human papillomavirus (HPV) as well. After age 65, women do not need to receive a Pap test unless they are at a high risk of cervical cancer. Additionally, testing is not recommended for women who have received a hysterectomy and have no history of cervical cancer or abnormal test results. These changes were made because cervical cancer is rare for young women, and grows at such a slow rate, that longer intervals between tests is not harmful.

Recent data shows that although some of these guidelines are being followed, others are not. Looking at positive trends first, the percentage of women aged 18 to 21 who have not received a Pap test has increased from 26% in 2000 to 48% in 2010. Additionally, the percentage of women over age 65 (who have not had a hysterectomy) that have recieved a Pap test has gone down slightly, from about three-quarters in 2000 to two-thirds in 2010.

However, there are also several negative trends visible. The percentage of women between ages 21 and 30 who have never received a Pap test has increased from 7% in 2000 to 10% in 2010. Another shocking statistic indicates that about 60% of women who have had a total hysterectomy, which means they no longer have a cervix, are still receiving Pap tests. While unnecessary tests cost money, they can also produce false results, anxiety, and additional tests and procedures. With increased dissemination and awareness of Pap test guidelines, physicians can work with their patients to provide appropriate care.

Sources:

• Hensley, Scott. "Pap Tests for Cervical Cancer are Often Wasted." NPR.org. 3 January 2013.
• Stein, Rob. "Doctors Revise Guidelines for Pap Smears." NPR.org. 14 March 2012.

Where do you get your health information?   Doctors are often too busy to spend much time on preventive care.   The internet is alive with personal and commercial  blogs on the latest health fads. And most recently, politicians are getting into the act.

The latest bruhaha about the HPV vaccine has been front and center in the presidential debate and has hit the airwaves.   In case you are not following this case, one presidential candidate has raised concerns about the safety of the HPV vaccine given to teenage girls to prevent cervical cancer.  And her source:   a woman she met on the campaign trail who said her daughter is mentally retarded due to the vaccine.   Even though this presidential candidate admits that she personally is not a "doctor" or a "scientist",  she still cites this mother's concern in the media as evidence that this HPV vaccine is dangerous!  There was no followup to see if there was any truth to the mother's assertion.   In my mind, what this candidate is doing IS  dangerous because she is using her celebrity status to spread unsubstantiated information about a serious women's health issue!

The Institute for Women's Health Research at Northwestern U. has created this blog site as an authoritative resource for women (and men) around the globe to learn about the latest (evidence-based) research in women's health.   Our sources include the leading scientific institutions around the world.   We also try to put risks and benefits into perspective based on the LATEST EVIDENCE so that you can decide what is best for you.  We acknowledge that science constantly evolves making it even more important the we continue to monitor the latest findings.  And the internet is certainly a good way to keep up.....if you use it wisely.

The good news about this latest political gaffe, is that even the talk shows are pointing out how absurd this candidate's assumptions are.  Maybe it will shed light on how important it is to find credible source for your health information.     By the way, please check out our recent blog on the HPV vaccine by clicking HERE.

A survey of more than 1,200 primary care physicians indicates that many are not following clinical practice guidelines on recommended screening intervals for cervical cancer, both with regard to traditional Pap testing as well as a newer screening method, a DNA test for the human papillomavirus (HPV). The FDA has approved HPV DNA testing for use in conjunction with Pap testing, a process called co-testing, for women age 30 and older.

At the time the survey was conducted, guidelines from the American Cancer Society and those from the American Congress of Obstetricians and Gynecologists advised extending the interval between screenings to 3 years for low-risk women over the age of 30 after three consecutive normal Pap tests or a single normal co-test (a normal Pap test plus a negative HPV DNA test). Guidelines from the U.S. Preventive Services Task Force also are consistent with a longer interval between screening tests.

In the survey, based on a hypothetical clinical vignette of a 35-year-old, low-risk woman with three prior normal Pap tests, only 32 percent of respondents reported that they would comply with guideline recommendations, researchers from the CDC and NCI reported in the June 14 Archives of Internal Medicine. Even fewer respondents, 19 percent, would comply when, during a single visit, the low-risk woman had a normal co-test result. Approximately 60 percent of those surveyed—which included general internal medicine physicians, family practice doctors, and obstetrician-gynecologists—said they would still recommend that the woman undergo annual Pap screening.

Although the Pap test is the most commonly used cervical cancer screening method, a number of studies have shown that the DNA test for HPV—the cause of the vast majority of cervical cancer cases—is more sensitive than the Pap test in detecting high-grade precancerous lesions, spurring discusions about the optimal approach to cervical cancer screening in the United States.

This new study, however, suggests that guidelines for extending screening intervals have not influenced current clinical practice, wrote Dr. Mona Saraiya of the CDC’s Division of Cancer Prevention and Control and her colleagues. “When offered the choice for HPV testing,” they wrote, “many physicians deferred to the same pattern they used for Pap testing,” annual screening with both tests or no recommendation for HPV testing.

“These practice patterns are not likely to lead to much improvement in cervical cancer outcomes, but may result in unnecessary follow-up testing, increased risk of colposcopy-associated morbidities, and distress for patients,” said Dr. Robin Yabroff, a study co-author from NCI’s Division of Cancer Control and Population Sciences.

“New HPV infections are extremely common but overwhelmingly benign; they almost always go away by themselves,” said Dr. Mark Schiffman of NCI’sDivision of Cancer Epidemiology and Genetics. “Only persistent infections are a risk factor for cancer. If you screen for HPV too often, you will detect new infections rather than persistent infections, and this poses the risk of overtreatment.”