U.S. Panel Advises PAP Test Once Every 3 Years

Issue 20, 2012

Other major changes to guidelines include no testing for women under age 21

After a thorough review of the latest evidence on cervical cancer screening, the influential U.S. Preventive Services Task Force (USPSTF) has updated its recommendations, extending the period between Pap tests to 3 years for most women.

In the first update on its guidelines since 2003, the independent panel of experts said that "screening women aged 21 to 65 years every 3 years with cytology [the Pap test] provides a reasonable balance between benefits and harms."

Citing the extreme rarity of cervical cancer for women under the age of 21, the panel is also advising no routine cervical cancer screening for women and girls in this age group, another departure from prior recommendations.

And while the panel ruled against routine use of the human papillomavirus (HPV) test as a cervical cancer screen for women under age 30, they recommended that "for women aged 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years" would be "a reasonable alternative." HPV is thought to cause the majority of cervical cancers.

However, the USPSTF said that the higher rate of false-positive results that comes with the HPV blood test "raises important concerns about unnecessary diagnostic testing (that is, colposcopy) as well as identification and treatment of precancerous lesions… that may regress." For that reason, routine screening with the HPV test is not recommended for women age 30 and under, the panel said.

In keeping with the 2003 guidelines, routine screening is also not advised for women at average normal risk for cervical cancer who are over the age of 65, or women who have undergone hysterectomy involving removal of the cervix and who have no prior history of cervical cancer or high-grade precancerous lesions.

The updated recommendations were echoed by similar guidelines issued recently by medical organizations, such as the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology.

The USPSTF recommendations were published in March in the Annals of Internal Medicine.

In a journal news release, Task Force Chair Dr. Virginia Moyer called the revisions "good news for women."

"Evidence shows that an annual Pap smear is not necessary to prevent deaths from cervical cancer," said Moyer, who is professor of pediatrics at Baylor Medical College. "Screening every 3 years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests."