Pap testing among women younger than 65 years is only necessary every three years and cervical cancer screening guidelines should be adjusted to reflect this, the U.S. Preventive Services Task Force recommends.
Many women are being tested too frequently, which could lead to overtreatment for low-grade cervical lesions that may not be cancerous, according to the organization.
“Evidence is convincing that many precancerous cervical lesions will regress and that other lesions are so indolent and slow-growing that they will not become clinically important over a woman’s lifetime,” task force members wrote in draft recommendations released this week.
They added that over diagnosis could result in potential treatment-related harms including “short-term increases in anxiety, distress and concern about health,” and invasive diagnostic procedures that could cause unnecessary pain, infection and vaginal bleeding.
The draft recommendations also suggest that cervical cancer screening be initiated at 21 years regardless of sexual activity levels — a departure from the organization’s 2003 recommendations, which stated that the appropriate gauge for when to begin screening was at age 21 or within three years a patient’s sexual debut.
Prior recommendations were based on the generally high prevalence of sexual activity among U.S. women aged 18 to 21 years and concerns that clinicians may not always obtain accurate sexual histories, according to the task force. However, data from recent studies indicate that invasive surgical cancer is rare among women younger than 20 years.
Additionally, little evidence supports continued Pap testing among those aged 65 years and older who have had “adequate prior screening and are not otherwise at high risk.”
Women who have undergone hysterectomies for previous benign disease are also exempt from screening in the draft recommendations. However, the task force noted that clinicians should confirm total hysterectomy using surgical records and physical exam. “Screening may be appropriate when the indications for hysterectomy are uncertain,” they wrote.
Currently, the the organization does not recommend one screening method over another, as data is insufficient on whether newer FDA-approved technologies, such as liquid-based cytology, are more effective then conventional Pap smear screening for preventing invasive cervical cancers.
The full draft recommendation is available for public comment on the U.S. Preventive Services Task Force website until Nov. 16, 2011.