July 22, 2010 — Most women should wait until age 21 to have their first Pap test unless they have compromised immune systems, according to updated guidelines from the American College of Obstetricians and Gynecologists, Reuters reports. Women younger than age 21 with compromised immune systems -- because of HIV, long-term steroid use or organ transplants -- should start screenings before 21.
The new ACOG guidelines address exceptions to Pap screening before age 21 in adolescents and reinforce ACOG guidelines issued in November 2009 recommending that women younger than 30 years have a Pap test every two years instead of an annual exam. The November 2009 guidelines altered prior recommendations that called for annual Pap tests starting three years after a woman becomes sexually active or by age 21.
The new guidelines were published online in the journal Obstetrics and Gynecology. ACOG fellow Mark Einstein of the Albert Einstein College of Medicine commented, "Over-screening adolescents is really detrimental to young women," adding, "We increase their anxiety, [and] we increase their time away from school and work" (Joelving, Reuters, 7/21).
According to ACOG, the Pap test is used to find changes in the cells of the cervix that could lead to cervical cancer. Although the main cause of cervical cancer is the human papillomavirus, only a few types of HPV cause cervical cancer, and infection with HPV rarely leads to cervical cancer (ACOG patient education pamphlet, December 2009). About 20 million U.S. residents carry HPV, which is the most common STI in the world, according to the Centers for Disease Control and Prevention. Widespread use of cervical cancer screening has lead to a more than 50% decline in U.S. cervical cancer rates in the last 30 years (Reuters, 7/21).
There is a screening test for HPV itself, but ACOG continues to recommend against HPV testing in adolescents. Cheryl Iglesia, chair of ACOG's Committee on Gynecologic Practice, said there is "no point in testing for HPV" among women under 21 "because it's so common among teens, and 90% of HPV infections are naturally resolved by the immune system within two years." She added that "unnecessary treatments compromise the cervix and increase a teen's risk of having a preterm birth later in life" (HealthCanal, 7/22).
According to Reuters, ACOG's new recommendations only address screening in women age 21 and younger (Reuters, 7/21). The new guidelines also recommend that any adolescent with one or more normal Pap tests prior to the 2009 guidelines should not be screened again until age 21. In addition, teens who have had prior abnormal Pap tests followed by two normal tests should wait until age 21 for additional screening (HealthCanal, 7/22).
First Ob-Gyn Visit Should Focus on Education, ACOG Says
The updated ACOG recommendations also advise young women to first see a gynecologist between ages 13 and 15, American Medical News reports. The first visit should focus primarily on education and guidance, and it should not include a pelvic exam or a speculum exam, absent of a medical reason to do so, according to the recommendations. Diane Merritt, chair of ACOG's Committee on Adolescent Health, said that the first exam should be "a learning experience that is age appropriate" (Albert Henry, American Medical News, 7/16).