Despite conflicting guidelines for cervical cancer screening during the past several years, fewer women received unnecessary Pap tests in 2010 than in 2000, according to a pair of analyses published in the Morbidity and Mortality Weekly Report by scientists from the US Centers for Disease Control and Prevention (CDC). But many continue to receive screening they are unlikely to benefit from.
Early identification of cancerous cervical lesions can help improve patient outcomes, which has led many organizations to recommend routine cervical cancer screening for women. But a growing body of evidence has suggested that cervical cancer screening in certain populations or screening performed at too-frequent intervals is not a good thing. Screening of women who are younger than 21 years or who have had a hysterectomy is unlikely to provide any benefit because these women have a very low risk of cervical cancer. Yet screening these low-risk individuals causes unnecessary health care expenditures and may lead to adverse events associated with testing or unnecessary treatments.
Studies have also found that annual screening for women between the ages of 21 and 30 years may also be excessive and contribute to unnecessary costs and potential harms from false-positive tests. However, until recently, guidelines from various health organizations differed on the appropriate screening criteria, and many women continued to receive unnecessary screening.
But in 2012, guidelines from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the US Preventive Services Task Force converged. They agreed that screening is not advised for women younger than 21 years or for women after age 65 who have a history of negative test results and that every 3 years for women aged 21 to 30 years is appropriate. Since 2003, there has been a consensus against screening women who have had a hysterectomy.
The new analyses of data from the CDC Behavioral Risk Factor Surveillance System by CDC scientists suggest that cervical screening practices may have begun changing to conform to the evidence base even before the guidelines converged. They found that in 2010, the percentage of women younger than 21 years reporting that they had never been screened for cervical cancer had increased from 23.6% in 2000 to 47.5%, suggesting fewer women are being screened this early. The percentage of women aged 21 through 30 years who reported having been screened in the past 12 months declined, from 78.1% to 67%. Additionally, declines in screening were identified for women who have had a hysterectomy (73.3% in 2000 to 58.7% in 2010) and among women who were 65 years or older (73.5% to 64.5%).