Task Force Calls for Reduced Pap Testing

Last week the U.S. Preventive Services Task Force (USPSTF), about which we wrote recently, weighed in with another advisory to cut back on what has long been standard gynecological practice.

As Reuters reported, although Pap smear tests are still the best practice for the prevention of cervical cancer, the USPSTF says that many women needn’t have one every year. The task force recommends the test be given every three years for most women.

Pap tests examine cells from the cervix for cancer or precancerous changes. The same cells can be used for HPV testing.

In proposing changes to its 2003 recommendations, the task force said evidence is still lacking to weigh risks and benefits of tests screening for human papilloma virus (HPV). That stance is opposite of most cancer patient advocates, who support such tests.

But the American Cancer Society agreed with the Feds on the new recommendations.

Routine annual Pap tests appear to present the same problems as the routine prostate-specific antigen (PSA) tests the task force addressed a couple of weeks ago, suggesting it be used only for high-risk men. “If you test every year you find a lot of benign infections that would go away on their own. … You end up overscreening, overmanaging and overtreating women who are not actually at risk of getting cervical cancer,” Philip Castle of the American Society for Clinical Pathology told Reuters.

“Everybody agrees on almost everything: Let’s get rid of regular annual Pap testing, let’s get rid of teenage screenings, let’s screen women who aren’t getting screened,” said Debbie Saslow, the American Cancer Society’s director of breast and gynecologic cancer.

Side effects of overtesting could include vaginal bleeding, pain, infections, risks of pre-term delivery and psychological issues about facing a possible cancer diagnosis.

Although the task force doubted the effectiveness of the HPV test in preventing cancer, other groups said the combination of regular Pap plus HPV testing was indicated for women older than 30 if done every three to five years.

The HPV virus is common, can cause genital warts and can lead to cervical cancer. As the Reuters story noted, usually, the immune system eradicates HPV, especially in younger women. The task force found HPV screening causing more false positive cancer results than the Pap alone.

Specifically, last week the task force recommended a Pap smear test every three years for women between the ages of 21 and 65 who have had sex and have not had their cervix removed. The panel found “little to no benefit” in screening women older than 65 who had been previously tested and not enough evidence of benefit for women younger than 21.

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