July 22, 2010

New Guidelines Say No Pap Smears For Women Under 21

New guidelines from the American College of Obstetricians and Gynecologists said that Pap smears in women under the age of 21 do more harm than good.

Dr. Mark Einstein of the Albert Einstein College of Medicine in the Bronx, New York told Reuters Health that in most cases these types of tests reveal only human papillomavirus (HPV) infections, which rarely lead to cervical cancer in women under 21.

"They have a better chance of winning the lottery than getting cancer at that age," said Einstein, who is an ACOG fellow but did not work on the guidelines.

Doctors usually perform a small biopsy of the cervix if a Pap smear shows abnormal results.

"Over-screening adolescents is really detrimental to young women," Einstein told Reuters Health. "We increase their anxiety, we increase their time away from school and work."

The new guidelines reinforce earlier recommendations issued in November 2009.  However, they add that adolescents with compromised immune systems should not wait until 21 to be screened.

Einstein said that even though this group makes up less than one percent of adolescents, their weak immune systems, caused by HIV infections, organ transplants or long-term steroid use, may allow HPV to develop into cancer easer than other individuals that are healthier.

Prior recommendations called for annual cervical cancer screening to start three years after a woman first becomes sexually active.

HPV is the most common sexually transmitted disease in the world.  According to the Centers for Disease Control and Prevention, about 20 million Americans currently are infected with HPV.

Cervical cancer rates in the U.S. have fallen in the past 30 years because of widespread use of cervical cancer screening.

ACOG recommended in its November 2009 guidelines that women between the ages of 21 and 30 should undergo cervical cancer screening every two years instead of an annual exam.  Women 30 and older can be screened once every three years.  The new recommendations do not refer to women between 21 and 30.

The new guidelines were published in the journal Obstetrics & Gynecology.


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