The pap smear was introduced in the 1960's in the United States, and since that time, the rate of cervical cancer has decreased dramatically.
Last year in the US there were only 12710 new cases. Most new cases now are diagnosed in women who have not had recommended screening
either because of lack of access or personal preference.
At the time pap smears were introduced, the decision to perform them annually was completely arbitrary. Because it was a new test, no one knew
how often it should be done. Since that time, much has been learned about what causes cervical cancer. We now know that ninety-nine percent of
cervical cancers are caused by high risk types of the human papilloma virus. We have also learned a lot about the natural history of the human papilloma virus.
In fact, the majority of cases of hpv will be transient, in other words the patient's own immune system will successfully fight the virus so that the infections remain insignificant
and never lead to precancerous or cancerous disease. In fact if we test too often, we will end up doing unnecessary procedures on women who will "get well"
on their own without intervention.
In addition, we now have new medical technology that allows testing of cervical samples for the presence
of the hpv virus. Using the two tests (pap and hpv) together permits earlier diagnosis of precancerous conditions in women with positive tests, and in turn, permits
women with negative test results to go longer in between screenings.
Because of all this new knowledge and insight, the American Society for Colposcopy and Cervical Pathology now recommends the following screening:
For Women under 21: No testing
For Women aged 21-29: testing with cytology (pap smear) only, every 3 years
For Women aged 30-65: Co testing with cytology(pap smear) and hpv testing every 5 years
For Women aged 65 and above, or after hysterectomy for benign (non cancerous) disease: discontinue testing
These recommendations are quite a radical departure from the previous yearly pap smears that many women were used to do, but the science indicates that
this testing will be frequent enough to permit detection of cervical cancers and pre cancers, but not enough to result in unnecessary procedures that can lead
to other complications.
The new guidelines are sure to come as a surprise (and probably a pleasant one) to many women.
For more information go to www.asccp.org