New Guidelines Advise Less Frequent Pap Smears

The annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.

In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer.

The new guidelines, issued on Wednesday by the United States Preventive Services Task Force, replace recommendations last issued in 2003 and use more decisive language to advise women to undergo screening less often. Other groups, including the American Cancer Society, released similar recommendations on Wednesday. The new guidelines were published in Annals of Internal Medicine.

“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”

Cost is not a factor in the task force recommendations. Instead, its members focus on the effectiveness of a screening test to reduce cancer deaths, balanced against the potential harms that accompany the screening. The worry about frequent Pap smear screening is that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk for pregnancy complications in the future, like preterm labor and low-birth-weight infants.

The new guidelines focus on four key areas, including frequency of screening, age at which women should begin screening, age at which women should stop screening, and testing for human papillomavirus, or HPV, which can cause cervical cancer.

Under the new recommendations, the task force says women should be screened with a Pap smear no more than every three years. In 2003, the language was weaker, recommending screening “at least every three years,” which left the door open for annual tests.

In addition, women now are advised to begin screening at age 21 regardless of sexual history, and the task force specifically recommends against screening women younger than 21. In 2003, the advice to women was to start screening within three years of sexual activity, but no later than 21.

The task force also recommends against screening women over the age of 65, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer. That advice has not changed since 2003.

Finally, the group also recommends against regular HPV screening for anyone under 30. In 2003, the task force said it did not have enough evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus will eventually eliminate the virus without any intervention.

“HPV in women under 30 is highly prevalent but also highly transient,” Dr. Nicholson said. “Women under 30 may get infected with HPV, but they have a high likelihood of clearing that infection on their own, and it not causing any long-term change to their cervical tissue.”

HPV testing should be used in certain cases where women receive atypical test results from a Pap smear. In addition, the task force said that women over 30 who do not want to undergo a Pap test every three years could instead opt for a Pap test every five years along with an HPV test.

The task force recommendations apply only to healthy women. They do not change the advice for women who have unusual symptoms, an unusual Pap test result or a history of dysplasia, cervical cancer, H.I.V. or other illnesses.