New Pap Smear Guidelines Advise Less Frequent Tests

Women should receive Pap screening no more than every three years, beginning at age 21 regardless of sexual history, say national guidelines released Wednesday. The new US Preventive Services Task Force (USPSTF) recommendations are for healthy low-risk women and do not factor-in cost considerations. They do not change the screening advice for women who have unusual symptoms or Pap results, or a history of dysplasia, cervical cancer, HIV or other illnesses.

USPSTF formerly advised getting a Pap smear "at least every three years," which left the door open to annual tests. The new guidelines make annual cytology (Papanicolaou smear) for healthy low-risk women a thing of the past. Dependent upon the outcome of the tests, women ages 30-65 may lengthen the screening interval to every five years using combined cytology and human papillomavirus (HPV) testing, USPSTF said. Pap testing is not recommended for women under age 21, or those older than 65 with adequate prior, normal screening results.

"We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce the potential harm of false-positive tests," said Dr. Wanda Nicholson, a USPSTF member and OB/GYN professor at University of North Carolina-Chapel Hill. "It's a win-win for women."

USPSTF recommends against regular HPV screening for women younger than age 30. "HPV in women under 30 is highly prevalent but also highly transient," Nicholson said. However, HPV testing should be used in some cases where Pap smear results are atypical.

Other groups, including the American Cancer Society, released similar screening guidelines on Wednesday.

The new guidelines, "Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement," were published ahead of print in Annals of Internal Medicine (2012;156:E-424). Visit www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full).