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Saturday, November 21, 2009
Group Urges Fewer Pap Tests
By Olivier Uyttebrouck
Journal Staff Writer
On the heels of a controversial study that suggested new guidelines for mammograms, another national group came out Friday with new guidelines developed by a University of New Mexico professor for when a woman should get a Pap test.
Women can wait longer between Pap tests and don't need to get their first screening until age 21, according to guidelines by the American College of Obstetricians and Gynecologists.
The guidelines previously recommended that girls get their first Pap test within three years of becoming sexually active, or by 21, whichever came first.
Dr. Alan Waxman, a University of New Mexico professor of obstetrics and gynecology, headed the ACOG review, which said most women in their 20s should receive Pap tests every two years instead of annually to catch slow-growing cervical cancer.
Waxman said giving Pap smears to teenage girls who are at small risk of developing cancer can do more harm than good.
"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," he said.
The new recommendations were released a day after a controversial study said regular mammograms to detect breast cancer should begin when a woman is 50, not 40.
Both have fueled the debate over President Obama's proposed health care overhaul as Republicans cite them as an example of government-rationed medical care.
ACOG is a nonprofit organization of physicians. Its new guidelines replace the group's 2003 recommendations.
The changes were prompted by new research in recent years showing that teenage girls are less vulnerable to certain conditions such as human papillomavirus, or HPV, that put older women at heightened risk of cervical cancer.
"Most young women who get HPV, it goes away by itself," Waxman said. "For most women, once it's gone, it never bothers them again."
Pap smears also detect some cellular changes that can be precancerous, said Waxman, who also helped write the 2003 guidelines. But, in young women, those changes typically go away as well, he said.
Consequently, teenage girls have a two-in-a-million incidence of developing cervical cancer, he said.
On the other hand, a common treatment for preconditions of cervical cancer can put women at increased risk of giving birth prematurely, Waxman said. Giving a Pap test to a teenager increases the likelihood she will undergo a potentially dangerous treatment, he said.
The timing of the Pap guidelines being released immediately after the new mammogram recommendations is coincidence, ACOG said.
While the two sets of recommendations are unrelated, they come at a time of intense debate over health care reform. Mammograms in particular have drawn broad attention in Congress, reflecting a more than decadelong debate in the cancer community about how best to perform mammograms.
Republicans sought to connect the mammogram recommendations to the health care overhaul, contending that such findings are the way that medical rationing starts.
Under the pending legislation, "nothing would prohibit the federal government from deciding if tests, treatments and procedures are too expensive, and therefore, unnecessary," Sens. Jon Kyl of Arizona, the Republican Whip, and Tom Coburn of Oklahoma, a physician, said in a joint statement.
But the Pap guidelines promise to be far less controversial as doctors have for years been told to perform fewer Paps among many women over 30, to cut back on unneeded care for the least at-risk — and there's growing understanding that overtreating younger women is an issue, too.
The guidelines also say:
• Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.
• Higher-risk women, such as those with HIV, other immune-weakening conditions or previous cervical abnormalities, need more frequent screening.
Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say that for now, vaccinated women should follow the same Pap guidelines as the unvaccinated.
The Associated Press contributed to this report.
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