PAP Smear Screening Update 2012

New cervical cancer screening guidelines by American College of Obstetrics and Gynecology, US Preventive Health Task Force, American Cancer Society and American Society for Clinical Pathology were published yesterday March 15, 2012 and reviewed on noon conference today. Many web sites (including some pages on CDC) are not updated yet to reflect this.

The take home?

Screening starts at age 21 regardless of age of sexual initiation.

Screening ends at age 65 in patients for those who have had appropriate screening and who do not have cancer history even if new sexual partner.

Generally speaking, PAP screening is every 3 years NOT annually if no abnormality.

Given prevalence and latency, do not do HPV co-testing in women under 30.

For women 30-65, Pap screening may be reduced to every 5 years if paired with HPV co-testing. If HPV co-test is positive, any abnormality is sent to colposcopy. If the HPV co-test is negative then ASCUS may be followed up in a year by the PCP.

Studies show that half of women with cervical cancer never had a PAP, but many women are having too many Paps! So do enough, not too many.

Screening for women

ACOG/ ACS/ USPSTF Guidelines:
http://www.acog.org/About_ACOG/Announcements/New_Cervical_Cancer_Screening_Recommendations

What to do with HPV co-test results
http://www.cdc.gov/std/hpv/pap/#table2

ACOG STD Screening Recommendations 2009
Sexually active women aged 25 years or younger should be screened for chlamydia, and all sexually active adolescents should be screened for gonorrhea. Urine-based screening without a speculum examination is sufficient for such screening, according to ACOG. However, pelvic exam may be used to look for STD's, if appropriate. ACOG also says that all adolescents and women aged 19 to 64 years who are sexually active should be screened for HIV, although frequency is not specified.

USPSTF STD Screening Recommendations
http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm

Data do not support pelvic exams for vulvar, vaginal, uterine or ovarian cancers.
A visible or palpable abnormality OR specific complaint initiates a diagnostic test not screening although appearance of condylomata alone do not indicate deviation from cervical cancer screening guidelines.

MODIFIABLE RISKS: About 100 women die in TN each year due to cervical cancer. Here is our state specific facts about cervical cancer and risk factors (diet, smoking, condom use etc):
http://hit.state.tn.us/Reports/SurveyReports/BRFSS_Factsheet/PAPsmear%20BRFSS%20FactSheets%20TN%202005.pdf

PREVENTION: Don't smoke, limit number of sexual contacts, use condoms. HPV vaccination.
Usual vaccination is around age 12, but catch up is outlined in this CDC document. Vaccination status does not alter screening guidelines.
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv-gardasil.pdf


ACCESS:For individuals you encounter who do not have access to breast and cervical cancer screening (due to insurance, SES), there is a been a federally funded program in place to help. Ours is at the Knox County Dept of Health. To search for sites throughout the country:
http://www.cdc.gov/cancer/nbccedp/screenings.htm

PATIENT INFORMATION ABOUT HPV AND CERVICAL CANCER, INCLUDING IMMUNIZATION AND MODIFIABLE RISK FACTORS:
http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf