If you were to ask a woman how often she should be getting a Pap smear to screen for cervical cancer, she would probably tell you every year. But for most low-risk women, screening for cervical cancer should be done far less often.
Annual cervical cancer screening for most women is a thing of the past, according to revised guidelines from four national organizations — the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, the American Society for Clinical Pathology, and the American College of Obstetrics and Gynecology.
New recommendations continue to advise health-care providers not to begin cervical cancer screening until age 21 years, and recent changes recommend women in their twenties receive a Pap smear every three years. HPV DNA co-testing should not be performed in this age group.
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Women aged 30 through 65 years should have a Pap smear and HPV DNA co-testing every five years. Those who have had a total hysterectomy and have no history of cervical intraepithelial neoplasia (CIN) 2 or higher do not require further screening.
Cervical cancer screening can be discontinued in women aged older than 65 years that have no history of CIN 2 or higher and have adequate negative screening results within the past 10 years.
Recommendations for less frequent cervical cancer screening are evidence-based and logical, given the progression of the disease and the decline of cervical cancer rates among women who receive screening.
The HPV virus is very common in adolescents and women in their early twenties; however, these patients’ immune system typically clears the virus in about 8 to 24 months without any sort of treatment. Additionally, cervical cancer is a disease of slow progression; therefore, less frequent screening is appropriate.
Some anxious patients will insist on continued annual cervical cancer screening and blame insurance companies for the guideline changes, and there will be providers who continue to screen patients year after year purely out of routine.
But over screening for cervical cancer can lead to unnecessary procedures and treatments for cellular changes that would never result in cancer if left untreated. It is important that we as health-care providers spread the word to colleagues and patients alike to promote better understanding of the rationale behind the newest cervical cancer screening guidelines. Make sure you are doing your part to prevent unnecessary screening and treatment.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.
