AEGiS-WSJ: Pap Tests Not Always Needed

Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

Pap Tests Not Always Needed

Wall Street Journal - July 6, 2004
By Robert J. Davis, Staff Reporter of The Wall Street Journal

or decades, conventional wisdom has held that nearly every woman needed a Pap test every year to prevent cervical cancer. Recent studies suggest many women and their doctors continue to believe the claim and act on it, even though leading medical organizations now say such frequent testing often isn't necessary and that some women can safely stop Pap smears altogether.

***

The Pap test, which involves scraping cells from the cervix and viewing them under a microscope, allows doctors to detect and treat precancerous changes before they become deadly. Thanks largely to widespread screening, deaths from cervical cancer have declined dramatically during the past several decades.

But often, abnormalities detected by a Pap smear never become cancerous. Because there is no way to be certain, though, women with suspicious results may be subjected unnecessarily to expensive and invasive follow-up tests and procedures. When cervical cancer does occur, it typically develops slowly, over a period of 10 to 20 years.

Based on these factors, as well as research showing annual screenings to have very little benefit over less frequent testing, both the American Cancer Society and the American College of Obstetricians and Gynecologists have changed their guidelines in the past few years.

These groups -- along with the U.S. Preventive Services Task Force, an independent panel that makes recommendations about screening -- say that women age 30 and older who have had three normal Pap tests in a row should be screened every two to three years. Exceptions include those who have weakened immune systems, are infected with HIV or were exposed to the drug DES in the womb. They should continue to be tested yearly, as should women under 30, beginning at age 21 or three years after the start of sexual activity, whichever comes first.

Women who have had hysterectomies (with removal of the cervix) for noncancerous conditions can stop getting screened altogether, according to the guidelines. Because the risk of cervical cancer is lower for older women, the task force says it's also fine to halt testing at age 65 if a woman has a history of normal results. The American Cancer Society sets the age limit at 70, and the College of Obstetricians and Gynecologists has no specific recommendation.

But two studies published last month found that most women are being screened more frequently than recommended and that half of women who have undergone hysterectomies are being tested unnecessarily. In a survey last year of ob/gyns, 75% said they would never stop testing a patient. The same number recommended yearly Pap tests for low-risk women. Asked why, about 60% cited "patient demand" and 44% listed "legal concerns."

Pap smears typically cost $25 to $100 and are covered by insurance. Some doctors who don't follow the guidelines dismiss them largely as a cost-saving measure and worry that women who aren't screened yearly will stop coming in for regular checkups.

If you think you are being over-tested, don't cut back on or stop visits for Pap tests without discussing it with your doctor. If the two of you agree it is OK to do so, remember that annual gynecologic exams and other tests are still essential.

040706
WJ040706

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Broadway Cares/Equity Fights AIDS, Elton John AIDS Foundation, the National Library of Medicine, Pacific Life Foundation and donations from users like you.

Always watch for outdated information. This article first appeared in 2004. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2004. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .