Thursday, September 16, 2010
New national Pap Smear guidelines have been revised by the American College of Obstetricians and Gynecologists Committee (ACOG) to commence at age 21, regardless of the first age of intercourse. Prior, we were screening for cervical cancer within three years of first intercourse, or sooner depending on patient risk factors.
This has caused some confusion amongst patients and the staff. Patients often still come in asking for a pap earlier than age 21 (because that is what they are used to doing), and the staff is continuing to room these rather confused patients. Like with everything else, when shifting gears, it takes a period of transition and acclimation to new guidelines every time they are revised.
Why the delay in screening age, my patients often ask? For several reasons:
1. Studies show that screening prior to age 21 does not prevent enough cases of cervical cancer to warrant screening. Let’s face it, the pap is not a pleasant visit. We all dread it. Why place these helpless youngsters into an uncomfortable position year after year when it may not even prevent cervical cancer?
2. Cervical cancer is rare in this age group, and accounts for one to two cases per million women per year.
3. The risks of having procedures performed on the cervix in those less than age 21 may place them at risk of preterm labor later in life in pregnancy.
4. Most Human Papilloma Virus (HPV) infections, the main cause of cervical cancer, in women of this age group are transient and self-resolving.
5. Cervical cancer is a slow-growing cancer that takes years to develop, allowing ample time to be discovered after age 21.
There are a few exceptions, however, that may require screening prior to age 21 (which you should discuss with your personal physician):
• Those with a diagnosis of HIV.
• Those with a prior organ transplant.
• Those with a history of long-term steroid treatment.
• Those deemed higher risk by their personal physicians for any other reason.
Knowing all of this, I personally wouldn’t want a pap before I was 21 years old. Would you?