ACOG Revises Cervical Cancer Screening Guidelines

Article date: November 20, 2009

By: Rebecca Viksnins Snowden

The American College of Obstetricians and Gynecologists (ACOG) is now recommending women begin cervical cancer screening at age 21, instead of 3 years after the onset of sexual activity, as was previously recommended by the group. ACOG has also modified its recommendations for how often women should be screened for cervical cancer, a disease that affected 11,270 US women in 2009, according to the American Cancer Society (ACS).

ACOG's recommendations aren't very different than the guidelines currently outlined by ACS, which were last updated in 2002, according to Debbie Saslow, PhD, American Cancer Society, director of breast and gynecologic cancer.

"In June 2009, representatives from the Society, ACOG, and approximately 25 other organizations met to discuss cervical screening and management for adolescents. There was general consensus that new screening guidelines should recommend against adolescent screening and that screening should begin at age 21," said Saslow. "The Society will formally review the evidence and update our cervical cancer screening recommendations in the coming year."

Over the last 30 years, screening has decreased the cervical cancer incidence rate by half, according to ACOG. But screening prior to age 21 often leads to unnecessary follow-up treatment and emotional anxiety for young women who are actually at a very low risk for the disease.

"New data published since the Society, ACOG, and the US Preventive Services Task Force last updated their cervical cancer screening recommendations in 2002 and 2003 shows that not only is cervical cancer extremely rare in women younger than age 21 (1 case per million), but screening adolescents has not been successful in preventing these rare cancers," said Saslow. "Further, as the Society discussed in the publication of its cervical cancer screening guidelines in 2002, there are known harms associated with screening adolescents, and overtreatment is common."

When Should You Get Screened?

According to ACOG's new guidelines, women 30 and older should be screened for cervical cancer whether by conventional or liquid PAP test once every 2 years, instead of annually as was previously recommended. Like ACS, ACOG also recommends women 30 and older who have had 3 consecutive negative tests be screened once every 3 years. However, both groups recommend that certain women, including those with HIV or a weakened immune system, get screened every year. The same goes for women who have had previous cervical abnormalities, and women exposed to the chemical DES.

"For all other women, evidence shows that there is little benefit to screening more frequently than every 2-3 years, and that there is greater morbidity associated with annual screening," says Saslow.

The two groups' guidelines on when to stop screening are also similar -- around age 65 to 70, as long as a woman has had 3 negative tests in the last 10 years. Women who have had a hysterectomy for benign reasons do not need to be screened, both groups agree.

Cervical cancer screening guidelines have evolved as scientists have gained a greater understanding of how the disease develops. Almost all cervical cancers are caused by HPV (human papilloma virus), and most generally develop slowly.

"A key point remains that most women who die from cervical cancer have never been screened, or have not been screened in at least 5 years," says Saslow. "A well-proven way to prevent cervical cancer is to be screened, because screening can find pre-cancers before they can turn into invasive cancer. The American Cancer Society, like ACOG, recommends that women should be informed about the potential benefits, harms, and limitations of cervical cancer screening."

ACOG's new recommendations will be published in the December issue of Obstetrics & Gynecology.

For more information about ACS's current guidelines, see Cervical Cancer Prevention and Early Detection.

 Reviewed by: Members of the ACS Medical Content Staff

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.