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Dr. Caren Schaecher, St. Luke's Hospital

New guidelines suggest Pap test may not be needed annually

You still need to get a well woman exam each year, but you may now be able to get your Pap test less often. The American College of Obstetrics and Gynecology recently amended its recommendations for cervical cancer screening, commonly done with a Pap smear test. The new guidelines recommend cervical cancer screenings beginning at age 21, regardless of when a woman first has sexual intercourse. Between ages 21 and 29, screening is recommended every two years. Women 30 and older with three consecutive normal Pap smears can be screened every three years.

Cervical cancer is caused by infection with human papillomavirus (HPV), which is transmitted during sexual intercourse. HPV infections are most common in a woman's teenage years and early 20s. However, most healthy women develop an immune response that clears or significantly reduces the infection in eight to 24 months, and most strains of HPV are harmless. For women 30 and older, the chance of an HPV infection progressing to cervical cancer is extremely low. Because risk factors decrease with age and cervical cancer is a slow-developing cancer, it is reasonable to discontinue screening in women between 65 and 70 years of age with three or more consecutive normal Pap smears.

These new guidelines stress a conservative approach to screening for and treating abnormal cervical cells. They are based on the fact that the incidence of cervical cancer in young women is very low and because the standard follow-up and treatment for any abnormal results, which often involves removing part of the cervix to remove the abnormal cells, can have adverse effects. Recent studies have documented a significant increase in premature births in women previously treated for HPV infections. In considering future fertility of young women, it is important to avoid unnecessary procedures to the cervix.

A concern with the new guidelines is that a woman may incorrectly assume she only needs to see her doctor every two to three years when she needs her Pap test. Again, each woman still needs a well woman exam with her OB/GYN or primary care physician every year to get other important health screenings and a physical examination, including breast and pelvic exams. You should discuss the new guidelines with your physician to determine what is best for your health.

Dr. Caren Schaecher is a board-certified OB/GYN at St. Luke's Hospital. Call 314-576-0930 or visit her Meet the Doctor page.

This article was published in the St. Louis Post-Dispatch on September 8, 2011.

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