The American College of Obstetricians and Gynecologists (ACOG) has published new guidelines for cervical cancer screening. The details of these new recommendations will be published in the December 2009 issue of Obstetrics and Gynecology.

Annual Pap smears have dramatically reduced the incidence of advanced cervical cancer in the United States and have saved thousands of lives. However, there is increasing evidence that not all women need annual Pap smears.

Previously, ACOG recommended that women begin cervical cancer screening three years after first sexual intercourse or by age 21, whichever occurred first. Women under the age of 30 were advised to get Pap tests every year. Depending on their history, less frequent screening (every two to three years) was an option for older women.

The decision to change the recommendations was based on a review of the evidence, which suggested that later and less frequent screening prevents cervical cancer just as well, and avoids some unnecessary and potentially harmful interventions. Many adolescents develop cervical abnormalities that eventually resolve on their own. Treatment of these abnormalities may not be necessary and can increase the risk of premature births.

Updated recommendations are as follows:

• Cervical cancer screening should begin at the age of 21.
• Most women under the age of 30 should be screened every two years.
• Women age 30 and older who have had three consecutive normal Pap tests can be screened every three years.
• Women with certain risk factors may need to be screened more frequently. These risk factors include HIV positivity; immunosuppression; DES exposure in utero; or history of treatment for cervical intraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer.
• Women who have had a total hysterectomy (removal of the cervix and uterus) for reasons other than cancer can stop being screened for cervical cancer unless they have a history of high-grade CIN.

The upper age limit for cervical cancer screening has not changed: ACOG notes that women may be able to stop cervical cancer screening at age 65 or 70 if they’ve had three or more normal Pap results in a row and no abnormal Pap in the previous ten years. Women at high-risk of cervical cancer may need to continue screening beyond this age.

Women who have been vaccinated against human papillomavirus (HPV) should follow the same screening guidelines as unvaccinated women.

Comments: These guidelines will hopefully decrease the number of non-indicated Pap smears.

Reference: ACOG news release. First Cervical Cancer Screening Delayed Until Age 21. Less Frequent Pap Tests Recommended. Available at: http://www.acog.org/from_home/publications/press_releases/nr11-20-09.cfm Accessed November 20, 2009.