New Pap Smear Recommendations

Some experts were up in arms over the recommendations issued by a U.S. government task force that advises women to push off breast cancer screenings until the age of 50. But the new guideline on Pap smears as issued by the American College of Obstetricians and Gynecologists (ACOG) was welcomed. A Pap smear involves swabbing a woman's cervix and examining the resulting sample to see if it contains abnormal (cancerous) cells.

The new guideline states that women who remain celibate needn't begin having Pap smears until the age of 21. The former recommendation was that women in their 20's needed to be tested each year. But now ACOG advises women to have the test only every two years. Even better, once a woman is over the age of 30, if she has had three normal Pap smears in a row, she can space her Pap smears even farther apart: once in three years. Women past the age of 65, who have passed three Pap smears in a row with flying colors can dispense with the smears, altogether.

More Sensible

Doctors are ready to change these guidelines because statistics tell them that young women are more at risk for sexually transmitted diseases (STD's) than for cervical cancer. Testing for STD's therefore makes more sense than giving women annual Pap smears. Rates of HPV, for example, are extremely high in younger women and this virus is linked to the development of cervical cancer.

Women in their 20's who have HPV would have abnormal Pap smear results, but younger women wouldn't. Women who get HPV before the age of 21 tend to have a spontaneous recovery from the virus within one year. Because of this fact, it's not necessary or even a good idea to force teens to submit to the trauma of a test that involves the insertion of a speculum into the vagina. That said, in every single country that decided to offer Pap smears, the number of deaths due to cervical cancer dropped.

Rare Cases

Of course, there are women who should be considered exceptions to these rules: a very small percentage of women younger than 21 should be categorized as high risk and should receive Pap smears on a regular basis. Among their numbers would be younger women who are positive for HIV or women on immunosuppressive drugs because of a kidney transplant, for instance. Even rarer is the woman in this age group who has received a diagnosis of severe dysplasia. She too, must receive regular Pap tests. But the group of women under the age of 21 who should have regular Pap screens occupies a position of less than 1% of their peer group. 

While most women below the age of 21 are at minimal risk for cervical cancer, those who are sexually active should still have annual screening for STD's. The same applies to men in this age group who are sexually active.  

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