March 15, 2012 — The U.S. Preventive Services Task Force on Wednesday issued new guidelines recommending Pap tests for women ages 21 through 65 every three years to screen for cervical cancer, the New York Times' "Well" reports. The guidelines' language on the three-year interval is more decisive than in the last version, which was issued in 2003 and was more open to annual screenings as an option. Although Pap tests have long been a part of annual gynecological exams for many women, medical groups in recent years have begun urging less frequent screenings (Parker-Pope, "Well," New York Times, 3/14).
The USPSTF guidelines, published in the Annals of Internal Medicine, mostly align with guidelines released on Wednesday by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology that also call for increasing the window between screenings (Pittman, Reuters, 3/14).
USPSTF said that a Pap test with an HPV test every five years also is a safe option for women ages 30 through 65 (Burton, Wall Street Journal, 3/14). For that age group, the medical groups' guidelines favored the five-year interval using both tests, rather than Pap tests alone at three-year intervals, although they said either is acceptable (Reuters, 3/14). Although some doctors already use co-testing, it was not formally recommended until now. Both USPSTF and the medical groups noted that the presence of HPV in women ages 30 through 65 could signal a persistent infection that would raise cancer risk, which is why co-testing is valuable for that group. Both guidelines also advise against screenings for women younger than age 21 and older than age 65 (Roan, Los Angeles Times, 3/14).
The task force does not consider cost in its recommendations. The guidelines balance the effectiveness of screenings in reducing mortality from cervical cancer with the potential harms from false positives in Pap tests. According to "Well," there is concern that frequent Pap tests can result in a significant number of false positives that can lead to biopsies and raise women's risk for pregnancy complications ("Well," New York Times, 3/14).
Michael LeFevre, co-vice chair of the task force, said studies show that the mortality rate for cervical cancer is not affected by lengthening screening intervals. According to LeFevre, at least half of U.S. women diagnosed with cervical cancer have not been screened. About 11,000 U.S. women are diagnosed with cervical cancer and roughly 4,000 die from it annually, largely because they were not screened and the disease was detected too late (Los Angeles Times, 3/14).