March 14, 2012 at 5:08 PM ET
Most women can go as long as five years between cervical cancer screenings as long as they make sure to get both a Pap smear and an HPV test when they do get examined, a government panel said Wednesday.
The interval between cervical cancer screenings can safely be extended for women between the ages of 30 and 65, according to the new recommendations from the U.S. Preventive Services Task Force.
Women ages 21 to 30 should still get a Pap smear every three years, the interval currently recommended. But those younger than 21 and older than 65 can skip the screen altogether, the experts concluded.
The panel is urging a extended intervals in screenings in an attempt to cut back on the number of women who end up being treated for lesions that might resolve on their own.
The downside could be a very small potential increase in the number of women who might die of cervical cancer, experts said.
“It’s a trade-off,” said Dr. Michael LeFevre, co-vice chair of the task force and a professor of family and community medicine at the University of Missouri at Columbia.
While screening more often might turn up more cancers and pre-cancerous lesions, it would also lead to far more unpleasant and painful therapies for women who might ultimately not have needed them, LeFevre said.
When a lesion is found, generally a colposcopy is ordered, said Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico.
And the often painful test can amount to a lot of unnecessary suffering given that many lesions frequently disappear on their own. For women who’ve never experienced a colposcopy, Waxman offered this description: “It’s like a Pap test on steroids.”
Beyond this, lesions may end up being excised in an uncomfortable procedure that can impact future fertility, the task force found. Studies have shown that some treatments for precancerous lesions can result in adverse pregnancy outcomes, including pre-term delivery, an infant that is underweight at birth, or even stillbirth or death shortly after delivery.
Until experts can find a way to cut back on colposcopies and excisions for precancerous lesions, it makes sense to screen less often because this will give some lesions time to resolve on their own, Waxman said.
He predicted that the new recommendations will take time to be accepted into practice.
“I anticipate there will be some apprehension among ob-gyns about it,” Waxman said. “It’s something new. And there’s always a concern if you screen less often you’re going to miss disease.”
Dr. Thomas Randall is one of those who isn’t yet convinced that the proposed changes are the best solution.
One thing missing from the new recommendations are studies that look at how women feel about treatment issues, said Randall, director of gynecologic oncology at Pennsylvania Hospital.
“I applaud the panel’s effort to minimize the emotional and physical burden of treatment on patients,” Randall said. “But I think we need to think very carefully about what patients’ preferences actually are.”
Beyond this, Randall said, it might make more sense to look at ways to decrease the number of colposcopies and excisions rather than cutting back on screening.
“Limiting screening seems a little paternalistic,” he explained. “Maybe we should be looking more at treatment patterns than at screening patterns in order to decrease the burden of treatment.”
The new recommendations were published in the Annals of Internal Medicine.