Postponing Pap Smears

December 13, 2009

While a controversial recommendation by a government task force that tells women to postpone breast cancer screening until they turn 50 has women and their doctors up in arms, a new guideline for Pap smears from the American College of Obstetricians and Gynecologists (ACOG) was much better received. Pap smears involve a swabbing of the cervix which is then analyzed for the presence of cancerous cells.

Sexually Active

The new recommendations state that even women who are sexually active needn't begin having pap smears until they turn 21. Furthermore, whereas the early recommendation had women in their 20's running for testing every year, ACOG now tells women to have the test only once every two years. Women over the age of 30 who have had three consecutive normal Pap smears will need testing only once every three years. Women over the age of 65 with three consecutive normal Pap smears can happily stop getting tested altogether.

Minimal Risk

Doctors feel these guidelines are reasonable because young women should be focused more on screening for sexually transmitted diseases (STD's) as opposed to cervical cancer, for which their risk is minimal. The rate for HPV is very high in young women and this virus is known to cause cervical cancer. If a woman 21 or older were found to have HPV, she'd have an abnormal Pap test, but younger women don't have this issue. In women under 21, 90% of HPV clears up within a year. It's therefore unnecessary to cause trauma to adolescents by administering a test involving a speculum. Still, in every country that has begun screening, rates of mortality from cervical cancer have gone down.

There are, however, always exceptions to rules and there are a small number of women under the age of 21 who are considered high risk and should be having Pap smears. Young women who have HIV or female kidney transplant patients on immunosuppressive drugs should undergo Pap tests. A rare number of women in that age group are diagnosed with severe dysplasia and these too, should undergo Pap tests. However, it's important to remember that such young women represent less than 1% of their age group.

Even though most women under the age of 21 aren't at risk for cervical cancer, if they are sexually active, they should have annual testing for STD's. Sexually active men in this age group should also be having such yearly testing.



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