Update on Cervical Cancer Screening

Abstract

Laurel Halloran, PhD, APRN Are you ready to give up the sacred cow of the annual the Papanicolaou (Pap) test? Cervical cancer used to be the leading cause of cancer death for women in the United States. However, in the past 40 years, the numbers of cases and deaths from cervical cancer have decreased significantly. In 2009, (the most recent year numbers are available) 12,357 US women were diagnosed with cervical cancer and 3,909 died from it. Since then, the American Cancer Society (ACS), along with the US Preventive Service Task Force (2012), the American Congress of Obstetricians and Gynecologists [ACOG] (2009), the American Society of Colposcopy and Cervical Pathology (2012), and the American Society for Clinical Pathology (2012) have all issued guidelines and extended the time between Paps for most women. However, many women are still getting the exam annually. Many practitioners claim that the annual Pap is the only reason patients come in every year, and often women continue to insist on annual screening. Yet these respected organizations have been recommending less frequent screening based on strong evidence and the reasoning that it takes a very long time for cervical cancer to develop. Screening too often can lead to unnecessary procedures. Sometimes Paps find cervical changes that lead to additional testing and treatment but turn out to be harmless. The more often women are screened, the more likely they are to be subjected to these unnecessary procedures, some of which carry risk factors of their own. This has been a very difficult message for health care providers and patients to accept. Dr. Justine Wu’s Hot Topic lecture in 2012 reviewed the most up-to-date recommendations for cervical cancer screening for implementation into practice. Those guidelines now include the following: For patients under the age of 21, no cervical cancer screening is recommended,