Doctor criticizes new guidelines

A local gynecologist says the likely unintended consequence of new guidelines on cervical cancer screening, or the "Pap" test, will be that women may forgo annual checkups that detect other problems, such as sexually transmitted diseases and ovarian cancer.

"We're going to miss other problems," said Dr. James Martin, an obstetrician and gynecologist with Trident Health System, noting that the Pap test often helps bring in women for annual exams.

There are 11,270 new cases of cervical cancer and 4,070 deaths per year in the United States. One to two cases occur per 1 million girls ages 15-19, a low incidence that convinces many doctors it is safe to wait until 21 to screen.

Long-held recommendations called for yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

The new guidelines, released Friday by the American College of Obstetrician and Gynecologists, recommend women delay their first Pap test until age 21 and be screened less often than recommended in the past.

Specifically, the guidelines say women 30 and older who have three consecutive Pap tests that are normal, and who have no history of seriously abnormal findings, can stretch the interval between screenings to three years.

In addition, women who have a total hysterectomy (which removes the uterus and cervix) for a noncancerous condition, and who had no severe abnormalities on previous Pap tests, can quit having the tests entirely.

The guidelines also say that women can stop having Pap tests between 65 and 70 if they have three or more negative tests in a row and no abnormal test results in the past 10 years.

The doctors' group also recommended it was safe to test women less often because cervical cancer grows slowly, so there is time to catch precancerous growths.

The new guidelines are an attempt by the group to decrease unnecessary testing.

Cervical cancer can be caused by the sexually transmitted human papillomavirus, or HPV, which is prevalent. Only some people who are exposed to it develop cancer; in most cases, the immune system fights off the virus.

If cancer does develop, it can take 10 to 20 years after exposure to HPV.

Regardless of the Pap test guidelines, Martin recommends that women under age 21 start having annual exams when they have problems or become sexually active. After age 21, women should see a gynecologist annually regardless of problems.

He adds that he will tell patients about the new guidelines but also treat each case individually.

"You can't tell from one patient to the next how they will respond to the HPV virus," he said.

Martin said time will tell how both patients and insurance companies respond to the new recommendations on the Pap test, which costs about $75-$100. Insurance companies pay less. He speculated that some insurance companies may start not covering the test.

Friday's recommendations on cervical cancer screenings arrive on the heels of hotly disputed guidelines released last week by the 16-member U.S. Preventive Services Task Force calling for less use of mammography in women.

Reach David Quick at dquick@postandcourier.com The New York Times contributed to this story.