New guidelines, but that Pap test is still important
In June, when the United States Preventive Services Task Force presented a recommendation that said there is not enough evidence to determine the benefits or harm of an annual pelvic exam for women, a newspaper headline proclaimed the end of the “dreaded” exam. But gynecologists are saying, “not so fast.”
“I think it’s easy to misread the recommendations and say no one needs pelvic exams ever, but we know that is not true,” explained obstetrician/gynecologist Tara Chute, MD at Cape Cod Hospital OB/GYN. “The recommendations were for a very specific group of non-pregnant adult women who had no symptoms at all.”
The task force review also fell short because it only looked at four specific conditions and there are thousands of gynecological conditions, she added.
The four conditions the Task Force studied were ovarian cancer, bacterial vaginosis, genital herpes and trichomoniasis. Gynecologists find many other vaginal problems that a woman might not detect on her own, said Dr. Chute, such as vulvar cancer or lichen scoliosis, which is an autoimmune disorder that causes a thickening or a plaque that can be associated with pre-cancer of the vulva.
It’s also important to remember that screening for cervical cancer does save lives. A recent study done by Cancer Research UK concluded that there would be four to five times more deaths from cervical cancer if no screening was done. If all eligible women were screened, the death rate would be cut in half for women ages 35 to 49 and by two-thirds in women ages 50 to 64, the report concluded.
That study was backed up by a new study in the United States published in the journal Cancer on January 23, which revealed that previous estimates of cervical cancer deaths have been much lower than what actually occurs.
Previous estimates didn’t account for women who had their cervixes removed by hysterectomy, which eliminates the risk of cervical cancer. After adjusting for hysterectomy, black women’s mortality rate was 77 percent higher and white women’s mortality rate was 47 percent higher than earlier estimates.
Different Guidelines For Different Ages
Part of the confusion over screening comes from the guideline changes that occurred in 2012, Dr. Chute said. Prior to that, it was recommended that women get screened annually for cervical cancer. The current guidelines issued by The American Congress of Obstetricians and Gynecologists (ACOG), have extended the recommended time between exams.
For women who have always had normal results from previous cervical cancer screenings, they recommend a test every three years for women between the ages of 21 and 30, and every three to five years for women between the ages of 30 and 65.
“If a woman has had normal screenings per these guidelines, you can actually stop at 65,” Dr. Chute said. “The odds of a new onset lesion happening which then progresses to cancer – which takes on average 10 to 20 years – is unlikely. That woman is at more risk of mortality from some other cause like cardiovascular disease than cervical cancer.”
Pap Tests Are Better
Part of the reason the spacing has changed is that the pap tests have gotten better. Gone are the days of the little glass slide. Now lab technicians use liquid-based cytology. They not only look at cells under the microscope for abnormalities, but in those over the age of 30 they specifically test for Human Papillomavirus (HPV).
“HPV is associated with about 97 percent of cervical cancers,” Dr. Chute said. “There are many strains of HPV but there are certain ones that are more likely to cause changes including cervical cancer. So we test for what we call ‘high risk HPV strains.’”
Any actual symptoms such as unusual bleeding, burning, itching, cramping, pressure or a feeling of bulging should always be at least discussed with your doctor and, in most cases, a gynecological exam would be warranted, she said.
“I think it’s hard because women assume certain symptoms are normal but I think it’s important to have a conversation with a physician to determine whether that is true or not. It shouldn’t be assumed that you can go without having a gynecological exam – particularly for a period of years.”