Medical experts defend their advice on less frequent Paps

Revealed the same week as hotly disputed guidelines calling for less use of mammography, new recommendations for Pap smears might seem like part of a larger plan to slash cancer screening for women.

But the timing was coincidental, said Cheryl B. Iglesia, chairwoman of a panel of the American College of Obstetricians and Gynecologists that developed the Pap smear guidelines.

The group, which included the University of Utah School of Medicine's Howard Sharp, updates its advice regularly based on new medical information.

Iglesia said the latest recommendations, which say women should delay their first Pap test until age 21, and be screened less often than in the past, had been in the works for several years, "long before the Obama health plan came into existence."

She called the timing crazy, uncanny and "an unfortunate perfect storm," adding, "There's no political agenda with regard to these recommendations."

Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography -- which the obstetricians' group has staunchly opposed -- because there is more potential for harm from the overuse of Pap tests.

The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone.

But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix.

Women who undergo a loop electrosurgical excision procedure (LEEP) or cone biopsies may have trouble conceiving, and those who do get pregnant are at higher risk for giving premature birth, said Sharp, vice chairman for clinical affairs in the U. of U.'s Department of Obstetrics and Gynecology.

The new screening guidelines, he said, are designed to spare women from destructive treatments that could compromise their reproductive health.

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 1,000,000 girls ages 15 to 19 -- a low incidence that convinces many doctors that it is safe to wait until 21 to screen.

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

While the new recommendations have generally been expected, and well received, by the physician community, some patients are not yet comfortable with the proposed change in routine, Sharp said.

"A lot of patients are not quite ready to make that move, so it's taking some education. It takes some face-to-face conversation," he said.

Sharp stressed that it's important for women to hear the right message: While they may not need a Pap smear every year, they still need a yearly pelvic exam to be checked for ovarian, uterine and breast cancers, as well as other potential problems, such as coronary artery disease.

And, he notes, the women who are most likely to die from cervical cancer are the ones who haven't been seen by a gynecologist for many years; finding a way to reach this group remains a challenge.