Call off the Pap Rally?

After years of needlessly conducting countless Pap tests and subsequent follow-up exams on low-risk women, North American health organizations are finally moving to replace antiquated cervical cancer screening policies.

Wait a minute…what? Antiquated? You mean women don’t have to make annual appointments for those awkward and uncomfortable tests? Can we get a cheer going?

Don’t gimme a P! (P)
Don’t gimme an A! (A)
Don’t gimme a P! (P)

(Well, not as often anyway.)

According to an article in today’s Globe and Mail– “Cancer experts call for reduction in Pap tests” –Carly Weeks puts forth the notion that we may be booking more paps than we actually need.

North American women are often advised to get their first screening at the age of 18, and to do a test every year after that. But apparently, more screenings don’t necessarily result in lower disease rates.

Even though Weeks highlighted some guidelines for screening, her article made it apparent that there are still some inconsistencies that may confuse women. Check ‘um out:

  • The American College of Obstetricians and Gynecologists advises women not to get a Pap test until they’re 21, after that they should be screened every two years until they’re 29. From there, they only need to get screened every three years.
  • The Society of Obstetricians and Gynaecologists of Canada advises women to start getting tested within three years of becoming sexually active or by the time they’re 21, [and after that as often as their health care provider recommends…which Weeks doesn’t mention]
  • The province of Alberta advises women to start getting screened at age 21 or when they become sexually active, and every three years after that.
  • The provinces of British Columbia & Ontario advise women to get tested every year until they had three normal tests in row, and every two to three years after that.
  • The province of Saskatchewan still advises women to begin getting screened at 18.

Considering the variations, however slight, I wonder what this will do for that easy to remember routine. I remind myself of the appointment with the simple “once a year, in the clear.” My first thought after reading this was that I’d just start doing what BC and Ontario do, or continue to passively let my doctor decide.

But that doesn’t sound right, does it?

Maybe instead of arbitrarily adjusting to the new guidelines, we women should see this as a good opportunity to educate ourselves a bit more about the pap test and about how the risk of cancer and benefits of pap tests vary depending on several factors.

Because Weeks’ article spreads them around, I’ve  highlighted the major explanations for this shift in recommendations. Depending on who how old we are and how many of the following characteristics apply to us, I think we should have a well-informed conversation with our health care professionals and understand why, exactly, we’re doing this thing in the first place.

So, here we have it:

My summary of what to know, as gleaned from Weeks’ article
Recommendations are changing because…

– The incidence of cervical cancer among women in their late teens and 20s is actually not that high
– The disease can take years to develop, so tests don’t need to be as frequent
– Changes may prevent numerous unnecessary follow-up exams and potentially harmful procedures  on women who don’t have cancer.
– Human papillomaviruses (common STIs) can cause harmless abnormalities which are likely to self-correct
– Changes may decrease the number of unnecessary biopsies/other medical procedures
Public health officials need to  focus on women at higher risk (in their late 30s to 50s), those with many sexual partners, and those who simply never get screened
– Because many young girls are currently getting HPV shots, incidences of cervical cancer may decrease over the next few years, as will the need for constant pap tests (though this doesn’t meant that girls who got the shot won’t need pap tests because the HPV vaccine doesn’t protect against all viruses that can lead to cancer.)

More coverage:

The New York Times: Guidelines Push Back Age for Cervical Cancer Tests
U.S. News & World Report: New Pap Test Guidelines: Start Later, Have Fewer

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