New Cervical Cancer Screening Guidelines

For a long time, women were advised to get annual pap smears, especially if they had ever been diagnosed with HPV (human papillomavirus), a common sexually transmitted disease. Now, says the American Society for Colposcopy and Cervical Pathology, longer intervals are recommended-every five years for women 30 to 64, and those screenings should include both HPV and cervical cell anomalies (cytology).

The guidelines were published in the journal Obstetrics and Gynecology.

An accompanying editorial raised the same concerns of over-PSA testing: “In a move toward safety, the guidelines discourage intensive evaluation and treatment of women ages 21 to 24 years who have minimally abnormal cytology, a group at low risk of cancer but with a substantial risk of harm.”

Sometimes, like prostate cancer, cervical lesions often regress on their own, without aggressive treatment.

The guideline, as described on, advised women who have tested negative for HPV and positive for atypical squamous cells of undetermined significant (ASCUS) to be screened for cytology and HPV at three-year intervals. ASCUS is the most common abnormal test result, but it isn’t usually associated with HPV and, as MedPageToday said, “carries low risk for invasive disease.”

For women with ASCUS who haven’t been tested for HPV, screening should be more frequent initially-once a year-but after a negative test it can be repeated at three-year intervals.

Women older than 65 with ASCUS, however, should be screened annually.

Positive results from a Pap test can fall into several different pathologies, some requiring more frequent follow-up than others. So, as always, individual diagnoses determine individual screening guidelines. But, in general, Pap tests needn’t be repeated as frequently as once thought.

Adopting that practice, however, is challenging because, as noted in another study reported on MedPageToday, “Most physicians wanted female patients to undergo cervical cancer screening more frequently than recommended under published guidelines, …”

That was the conclusion of a government survey of physicians published in JAMA Internal Medicine. As many as 8 in 10 doctors surveyed said they would recommend women with normal Pap tests and negative HPV tests be rescreened in three, instead of the now-recommended five, years.

In an accompanying editorial headlined “Swimming Upstream,” Dr. Michael LeFevre said that the study results show that “doing less” in medicine remains challenging for doctors even if scientific evidence indicates that approach is best for most patients.

“It is important to acknowledge that getting physicians to do less testing and patients to accept less testing in many clinical situations is like swimming upstream; it is hard,” said LeFevre. “The forces to do more rather than less, particularly for ‘early detection’ of asymptomatic disease, are powerful.”

Our cultural belief that medicine does only good is the culprit here. But it seems to us that when you’re a doctor, you’re obliged to let science, not momentum, be your guide.

LeFevre believes that “some overuse of diagnostic testing in general and screening specifically” is the result of doctors worrying that if they don’t test they leave themselves open to charges of malpractice. And that lawsuits claiming excessive testing are not a compensating concern. This continuing refrain doesn’t get any truer by virtue of repetition.

He also explains that the fee-for-service payment model encourages overtesting because it means a bigger paycheck. Again, when the profit motive, not science, is your guide, the patient pays, figuratively and literally.

We agree with LeFevre’s conclusion that although screening tests will benefit some patients, “blind adherence to doing more whenever there is a possibility of good, no matter how remote that possibility is or how much harm is done in the process, should not be our approach.”

If you have been screened for prostate or cervical cancer, or HPV, and your doctor advises rescreening more frequently than these guidelines, find out why. Know your test results, and what they mean.

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