Cervical cancer: Screening recommendations can also confuse physicians

January 7, 2013 | by Shawn Le

Recommendations about cancer screenings are always evolving, as physicians and researchers learn more about how the disease develops and are able to analyze data from an ever-growing population of patients. The pace of change, though, can be confusing to both physicians and patients, with some physicians slow to adopt crucial recommendations.

 

Pap smears Pap smears, used to test for cervical cancer, aren't needed by women who've had a hysterectomy. But many get them anyway.

 

This problem was highlighted in a Dec. 3 report from the federal Centers for Disease Control and Prevention about screening for cervical cancer. The good news is that younger women are getting pap smears as recommended. The bad news is that 58.7 percent of women over 30 who had a hysterectomy – in which the woman’s uterus and uterine cervix are removed – are still getting regular pap smears despite recommendations that they don’t need to be tested.

Though the screenings don’t harm the women, they also don’t help. Such tests amount to a waste of precious health-care dollars. In 2012, new recommendations for cervical cancer screening were issued by three organizations – the U.S. Preventive Medicine Task Force, the American College of Obstetricians and Gynecologists, and the American Cancer Society.

The guidelines state:

  • Pap tests are not recommended for women under 21.
  • Women between 21 and 65 should be screened every three years. After age 30, the interval between screenings can be extended to every 5 years.
  • Pap tests are not recommended for women over 65.
  • Pap tests are not recommended for women who have undergone a total hysterectomy for noncancerous reasons, which account for 90 percent of cases.

Physicians walk a fine line in conducting cancer screenings. The major benefit of cancer screenings is catching the disease at an early stage when it is most treatable and curable. Lung cancer is a prime example.

 

The major drawback of cancer screenings is the possibility of unnecessary or over-treatment. Critics often point to prostate cancer screenings as proof. Routine screening of elderly men has led many to undergo invasive surgery or take life-altering medications for a disease that is so slow-growing they’ll die of a stroke or heart attack long before they die of prostate cancer.

Ensuring that patients get the most appropriate care is the point of evolving guidelines.

Keisha Houston, Ph.D., epidemic intelligence service officer with CDC’s Division of Cancer Prevention Control said in the center’s press release: “We need to remain vigilant and increase screening among women who would benefit most from this preventive service.”

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