New guidelines addressing when and how often women should get early detection tests for cervical cancer and pre-cancer were issued Nov. 14 by the American Cancer Society (ACS).

An expert panel developed the new guidelines outlining who should be screened, when they should be screened, and with which test.

Based on the new recommendations, most women would begin cervical cancer screening later, have an option to stop at a certain age (70 years), and be exempt from screening entirely if they have had a hysterectomy.

"The new guidelines will have a major impact on the number of women who are over-screened and over-treated," said Mary A. Simmonds, MD, FACP, national volunteer president of the ACS. "Because most cervical pre-cancers grow slowly, having a test every two to three years will find almost all cervical pre-cancers, and cancers while they can be removed or treated successfully.

"However, it is important to emphasize that the biggest gain in reducing cervical cancer incidence and mortality would be achieved by increasing screening rates among women who have not been screened or who have not been screened regularly," Simmonds said.

The ACS estimates that 13,000 women will develop invasive cervical cancer this year, and about 4,100 women will die of the disease.

The new guidelines, in summary form, are:

• Cervical cancer screening should begin about three years after a woman begins having vaginal intercourse, but no later than 21 years of age.

• Cervical screening should be done every year with regular Pap tests or every two years using liquid-based Pap tests. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. A doctor may suggest getting the test more often if a woman has certain risk factors such as human immunodeficiency virus (HIV) infection or a weakened immune system.

• Women 70 years of age and older who have had three or more normal Pap test results and no abnormal results in the last 10 years may choose to stop cervical cancer screening.

• Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer or pre-cancer. Some other special conditions may require continued screening. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.

A Pap test begins with a doctor removing cells from the cervix by brushing it with a special instrument. The cells are then sent to a lab to be examined under a microscope.

In addition, a promising new test for human papilloma virus (HPV), not yet approved for screening by the FDA, may be useful in detecting early cervical cancer in women over 30 years of age. If the test is approved, it may be added to the guidelines.

In order to develop consistent recommendations for women, the ACS worked with representatives of other government and health care organizations that have an interest in early detection of cervical cancer. ACS and other organizations will collaborate in an effort to promote and educate health care providers and the public about the new recommendations, according to a statement issued by ACS.

The full guidelines were released Nov. 14 in the journal CA, A Cancer Journal for Clinicians (Vol. 52, No. 6: 342-359). According to the authors, the guidelines continue to emphasize the importance of flexibility for women and their health care providers. They said screening should be based on discussions of the benefits, risks, and limitations of cervical cancer screening.

The authors underscored in the journal article the significance of identifying opportunities for screening for women of low income or low education, and women who are underinsured or uninsured. They said clinicians, hospitals, health plans, and public health officials should seek to identify and screen these women, and to ensure continued screening at regular intervals.