The incidence and death rates from cervical cancer in the United States have dropped almost 50% following widespread use of the pap tests that began in the early 1970s. Cervical cancer is still the third most common gynecological cancer in the United States; worldwide, it is the second most common cancer among women and the most common cause of death from a gynecological cancer.

The American College of Obstetricians and Gynecologists (ACOG) has released revised clinical guidelines for the frequency of pap tests and other cervical cancer screening recommendations. The guidelines are evidence based, and were published in a practice bulletin July 31, 2003. Changes are the result of newly available tests for detecting cervical changes as well as improved understanding of the pathology and evolution of cancer. The following is a summary of the ACOG recommendations:

* First Screen: Women should have their first pap test (a screening of cervical cells) approximately 3 years after first sexual intercourse or at age 21, whichever occurs first.

* Women up to age 30 should undergo annual cervical cytology screening because these women have a higher likelihood than older women of acquiring high-risk types of HPV that may cause precancerous changes. These changes must be ruled out before extending the testing intervals.

* Women ages 30 and older have two acceptable options:

1. Testing using cervical cytology alone; if a woman age 30 or older has negative results on three consecutive annual cervical cytology tests then she may be rescreened with cervical cytology alone every 2 to 3 years.

2. The combined use of a cervical cytology test and an FDA-approved test for high-risk types of human papillomavirus (HPV). Once women test negative on both tests they should be rescreened with both tests no more often than every 3 years. Women who test negative on only one of the tests should be screened more frequently.

Exceptions

More frequent cervical screening may be required for persons who are infected with HIV, are immunosuppressed, were exposed to DES in utero, or were previously diagnosed with cervical cancer.

Women who have had a hysterectomy with removal of the cervix for benign reasons and with no history of abnormal or cancerous cell growth may discontinue routine cytology testing. Women who have had a hysterectomy but have a history of abnormal cell growth (CIN 2 or 3) should be screened yearly until they have three consecutive negative vaginal cytology tests, after which time routine screening may be discontinued.

When to Discontinue Screening

The American Cancer Society calls for cessation of testing in the not-high-risk group at age 70, and the U.S. Preventive Services Task Force by age 65; ACOG notes that due to limited studies of older women it is difficult to set across-the-board upper-age limits for cervical cancer screening. Regardless of when the cervical screenings are discontinued, an annual gynecologic exam that including pelvic exam remains necessary (ACOG, 2003).

Although many physicians recommend a pelvic exam and a pap test for women over 18, recent studies have shown these screenings are unnecessary. However, women over the age of 21 should have annual pelvic exams.

REFERENCE