For over 50 years the annual Pap test has been a yearly ritual for many women. Both patients and providers look at the PAP as the focal point of the annual or yearly well-woman exam. It motivates women to return to the office year after year. Now new evidence suggest the Pap test should be started at an older age and performed less often in low risk women / per the American College of Obstetricians (ACOG), American Cancer Society (ACS) and the U.S. Preventative Task Force (USPSTF).
The Pap test is done to find early pre-invasive lesions on the cervix, so treatment may be done to stop the progression of the disease. This screening is a success because cervical cancer follows a course from first exposure, to the primary cause (HPV– Human Papillomavirus), to pre malignant changes to cancer – which take about 9 to 15 years. The median age at diagnosis with cervical cancer is about 48 years; and the usual age of death is 57 years of age. However, of the women diagnosed with cervical cancer almost 50% never had a Pap test and 10% had not had a Pap test in the past 5 years. Improved testing that allows for longer screening intervals could remove some barriers to the screening in terms of cost and convenience, thus allowing more women to get the test.
Cervical cancer is extremely rare in women younger than age 21. Only 2 percent of the U. S. cervical cancer cases occurred in women under the age of 20. HPV infection is common at this age, though most infections clear without treatment in 1 to 2 years. It makes sense to delay screening until 21 to prevent patient harm from positive screening results (additional screening, colposcopies, and biopsy, excisional treatment, and emotional burden). The benefit outweighs the harm since most of these mild-to-moderate lesions will clear without treatment.
Co-testing the Pap with HPV testing is more appropriate in women ages 30 and older. In women 30 and older the virus is a more persistent infection since the rate of cervical cancer increases. If both tests are negative, they can be repeated in 3 years in low risk women.
Women who have risk factors (HIV, immune-compromised, has had abnormal pap tests, and cervical cancer or changes in their sexual history) should be screened more often.= Women who had a hysterectomy due to benign reasons, the new recommendation is to stop screenings. The upper age to stop screening is now around the age 65 to 70 if the patent has had 3 consecutive normal pap tests and no abnormal test in the past 10 years.
Below are the new guidelines. At Adagio Health, we adopted the new guidelines per ACOG. Remember that these are only guidelines and all providers will follow each client as he or she feels is necessary for their best health care. Studies have shown that the risk of cervical cancer is the same in women who follow these guidelines and those who have yearly Pap tests.
· Age 20 and under – adolescents women with a history of sexual activity should have annual examinations but avoid Pap tests until they are 21
· Age 21– women should begin to be Pap tested at age 21
· Age 21 until age 30 – women should have a Pap test every 2 years. After three normal Pap tests in a row, she may have a Pap test every 3 years if:
· She does not have a history of moderate or severe dysplasia
· She is not infected with HIV
· She does not have a weakened immune system
· She does not have a history of DES exposure
Information is from THE JOURNAL FOR NURSE PRACTITIONERS.
The Women’s Health Task Force meets the first Thursday of each month, in the second floor Auditorium of the Multi Service Center, 650 Leonard Street in Clearfield, and beginning at noon. The next meeting will be held Aug. 5 and all interested persons are invited to attend.
Joan Kroell RNC, CRNP
Adagio Health, Clearfield