July 9, 2013
Yearly Pap Smears Still The Norm Despite Revised Recommendations
Susan Bowen for redOrbit.com - Your Universe Online
The requirement to receive an annual pap smear is deeply ingrained in the minds of most women and their doctors. However, in 2009 guidelines were revised to recommend screening every three years. According to a recent study conducted by Russell Harris and Stacey Sheridan of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, about half of the obstetrician/gynecologists studied still provide annual pap smears, despite the new guidelines.
In an editorial accompanying the study the authors wrote, "Screening is not the unqualified good that we have advertised it to be." In fact, they say, the annual exams may be more harmful than helpful.
Pap smears often produce abnormal results, but these results may never actually lead to cancer. Yet a positive Pap smear usually leads to additional, more invasive testing. One such test, called a colposcopy, requires an examination of the cervix followed by a biopsy, which can cause pain and bleeding.
Of more concern than any lasting physical damage is the possibility of psychological harm. "The screening test itself can raise concern about dreaded cancer; a positive screening test heightens this worry; finding a cancer precursor, even one of uncertain importance, just increases worry further," the authors explain.
The study found that "screening every three years [for cervical cancer] retains about 95 percent of the benefit of annual screening, but reduces harms by roughly two-thirds." Additionally, less frequent screening also reduces costs to both patients and providers.
So why are many doctors not following the new guidelines? The study reports that doctors said that they were comfortable with longer intervals between screenings, but that they worried that patients would not come for check-ups if they thought they would not get a Pap test.
Screening for cervical cancer is still important, but the benefits and risks of yearly testing need to be weighed carefully. In most cases, less frequent screenings will be just as effective.