New Guidelines Tackle Cervical Cancer Overscreening

Cervical cancer screening guidelines designed to minimize potential harms of overscreening

(RxWiki News) New guidelines may change many women's preventive health care routines — particularly when it comes to cervical cancer screening.

New guidelines from the American College of Physicians (ACP) focus on reducing the overuse of cervical cancer screening. According to these new guidelines, women who have only an average risk of cervical cancer and who have no symptoms may need screening less frequently than once thought.

“ACP’s advice for cervical cancer screening is designed to maximize the benefits and minimize the harms of testing,” said ACP President Dr. David Fleming in a press release. “Historically, physicians have low adherence to cervical cancer screening recommendations, beginning screening too early, performing screening too often, and continuing to screen women at low risk, either by age criteria or after hysterectomy with removal of cervix.”

Screening for cervical cancer at regular intervals can catch cancer in its early stages. Treatments like surgery, radiation and chemotherapy are most effective if started as soon as possible.

The ACP guidelines call for screening every three years after age 21 in women with an average risk for cervical cancer.

Some doctors feel that these screening intervals are too long, said Daniel Tobias, MD, chair of GYN Oncology at Morristown Medical Center and Overlook Medical Center in Summit, NJ, and director of the Women's Cancer Centers/Carol G. Simon Cancer Center of Atlantic Health System.

“Many gynecologists are concerned that extending time between Paps will cause patients not to come in for a general [gynecological] exam and miss an opportunity for health screening and early detection for other diseases besides cervical cancer, i.e. many patients think the only reason to visit a gynecologist is for a Pap smear,” Dr. Tobias told dailyRx News.

Cervical cancer is often cause by infection from some high-risk types of HPV (human papillomavirus).

The new ACP guidelines call for screening using a cytology test (Pap smear). A Pap smear might be uncomfortable, but they generally have few negative effects. However, if the test results in a false positive, it can mean the patient must undergo more invasive testing without good reason. Cervical biopsies and tissue removal can cause bleeding and discomfort, for instance.

Doctors may also use a combination of cytology testing and the HPV test. In the latter case, the new guidelines say screening intervals can be lengthened to five years in women ages 30 and older.

Women over age 65 need not be screened if they have had at least three negative cytology tests within 10 years, according to the new guidelines. The last of the three negative tests must have occurred by age 60.

These new guidelines also say women younger than 21 and women who have had a hysterectomy with removal of the cervix need not be screened.

Screening may help reassure women, Dr. Tobias said.

"The take away message for patients is that repeated negative Pap smears and HPV tests are quite predictive that a patient is not going to get cervical cancer over the next few years,” Dr. Tobias said.

Dr. Tobias added, “New guidelines are based on well-reviewed data and compiled by a panel of experts. Often it takes a while for practitioners to change their practice patterns because they become accustomed to how they have been practicing and need time to adjust to new recommendations.”

The new screening guidelines were published in the April issue of the Annals of Internal Medicine.

The ACP funded the researchers behind the new guidelines. Authors Dr. George F. Sawaya and Dr. Shalini Kulasingam said they received funds from the ACP.

Review Date: 
April 30, 2015