No Pap Smears for Women Under 21: Guidelines

From Reuters Health Information

By Frederik Joelving

NEW YORK (Reuters Health) Jul 21 - Pap smears in women under 21 do more harm than good, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) say.

In most cases such tests reveal only human papillomavirus (HPV) infections, which rarely lead to cervical cancer in women under 21, said Dr. Mark Einstein of the Albert Einstein College of Medicine (no relation) in the Bronx, New York.

"They have a better chance of winning the lottery than getting cancer at that age," said Dr. Einstein, who is an ACOG fellow but did not work on the guidelines.

"Over-screening adolescents is really detrimental to young women," he told Reuters Health. "We increase their anxiety, we increase their time away from school and work."

The new guidelines, published online today in Obstetrics & Gynecology, reinforce earlier recommendations issued this past November. But they add that adolescents with compromised immunity should not wait until 21 to be screened.

Although this group makes up less than one percent of adolescents, said Dr. Einstein, they are much more vulnerable to cancer from HPV.

Prior recommendations called for annual cervical cancer screening to start three years after a woman first becomes sexually active, or by age 21.

In the past 30 years, cervical cancer rates in the United States have fallen by more than half, due in large part to widespread use of cervical cancer screening.

In its November 2009 guidelines, ACOG recommended that women between 21 and 30 years undergo cervical cancer screening once every two years instead of annually. Those 30 and older can be screened once every three years. The new recommendations do not refer to women between 21 and 30.

SOURCE: http://link.reuters.com/juv78m

Obstet Gynecol 2010.