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Good Grief...get a grip! The new Pap smear recommendations were based on the guidelines of the American Cancer Society!

Posted by on Nov. 20, 2009 at 2:14 PM
  • 6 Replies

The new guidelines of the American Cancer Society (ACS) recommend initiating screening 3 years after onset of sexual activity but no later than age 21.4 ACS recommends annual screening with conventional Pap tests, or screening every 2 years if liquid-based cytology is used, until age 30; thereafter, the screening interval can be extended to 2-3 years based on past screening results and risk factors. Most other North American organizations have previously recommended beginning screening at onset of sexual activity or at age 18; these include the American Academy of Family Physicians (AAFP),28 American College of Obstetricians and Gynecologists (ACOG)7, American College of Preventive Medicine (ACPM),29 American Medical Association (AMA),30 the Canadian Task Force on Preventive Health Care (CTFPHC),31 and the American Academy of Pediatrics (AAP).32 Some of them may update their guidelines in light of the new recommendations on starting age. These organizations recommend that initial screening be conducted annually, but most recommendations permit Pap testing less frequently after three or more normal annual smears, based on patient risk factors and the discretion of the patient and physician.

Guidelines of the ACS,4 AAFP,28 ACPM,29 and the CTFPHC31 recommend discontinuing screening, or offering the option for patients to discontinue screening, after age 65 or 70 provided there is documented evidence of adequate past screening; details of what constitutes "adequate" past screening vary. No current screening guidelines specifically recommend using HPV testing for screening, or recommend newer Pap test technologies in favor of conventional Pap tests. http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm

You can see the ACOG (American Council of Obstetricians and Gynecologist) at http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm

some highlights: The tradition of doing a Pap test every year has not been supported by recent scientific evidence," says Alan G. Waxman, MD, at the University of New Mexico in Albuquerque and who headed the document developed by ACOG's Committee on Practice Bulletins-Gynecology. "A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful."

ACOG now recommends that women from ages 21 to 30 be screened every two years instead of annually, using either the standard Pap or liquid-based cytology. Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years with either the Pap or liquid-based cytology. Women with certain risk factors may need more frequent screening, including those who have HIV, are immunosuppressed, were exposed to diethylstilbestrol (DES) in utero, and have been treated for cervical intraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer

Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents which can have economic, emotional, and future childbearing implications. ACOG previously recommended that cervical screening begin three years after first sexual intercourse or by age 21, whichever occurred first. Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21. The immune system clears the HPV infection within one to two years among most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the large majority of cervical dysplasias in adolescents resolve on their own without treatment.

A significant increase in premature births has recently been documented among women who have been treated with excisional procedures for dysplasia. "Adolescents have most of their childbearing years ahead of them, so it's important to avoid unnecessary procedures that negatively affect the cervix," says Dr. Waxman. "Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own."

by on Nov. 20, 2009 at 2:14 PM
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Replies (1-6):
chair.r13
by on Nov. 20, 2009 at 2:16 PM

No, no no! We're all gonna die, Damn it!

mushmom
by on Nov. 20, 2009 at 2:17 PM

I was quite relieved about a year and a half ago when my gyn told me I didn't need to come back until 2 years.

chair.r13
by on Nov. 20, 2009 at 2:19 PM

Sorry, I couldn't resist. You know that the people who need to read that either 1) aren't going to or 2) won't comprehend the information, right? Nice try though, Momma! Thanks for putting it out there!

Quoting chair.r13:

No, no no! We're all gonna die, Damn it!


Trisha-Faye
by on Nov. 20, 2009 at 2:31 PM

I know..but I keep hoping!..lol.  I plan to periodically bump it so maybe it will at least get through to one.

Quoting chair.r13:

Sorry, I couldn't resist. You know that the people who need to read that either 1) aren't going to or 2) won't comprehend the information, right? Nice try though, Momma! Thanks for putting it out there!

Quoting chair.r13:

No, no no! We're all gonna die, Damn it!

 


Trisha-Faye
by on Nov. 20, 2009 at 2:50 PM

bump

teddysmom08
by on Nov. 20, 2009 at 4:49 PM

Welcome to Obamacare! This is only the beginning!

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