Pap Tests for Cervical Cancer Are Too Often Overused

Healthy cervix cells, gathered during a Pap test, as seen under a microscope. (Euthman/Flickr)

Healthy cervix cells, gathered during a Pap test, as seen under a microscope. (Euthman/Flickr)

January is Cervical Health Awareness month, and the Centers for Disease Control is celebrating by highlighting just how poorly the US is doing at following established guidelines.

In dual reports today, the CDC finds that many women are being screened for cervical cancer way too often — while other women are not screened enough.

Let’s start with the guidelines themselves. In 2012, three different groups, the US Preventive Services Task Force, the American Cancer Society and the American College of Obstetricians and Gynecologists all came to agreement: Women ages 21 to 65 should receive a Pap test — the definitive screen for cervical cancer — once every three years. If you’re either under 21 — or 65 or older, you don’t need one, barring certain limitations. (Some women opt for an additional HPV test and can be screened with a Pap test every five years.)

In addition, the overwhelming number of women who have had a total hysterectomy (in which the cervix is also removed) do not need any more Pap tests. As Dr. David Chelmow, a professor of obstetrics and gynecology at Virginia Commonwealth University Medical Center, told Reuters, “It’s tough to get cervical cancer without a cervix.”

The upshot from the CDC’s survey? Here are the numbers:

  • 41.5% of women ages 18 to 21 had a Pap test in the last year, despite the recommendations that they don’t need them
  • 58.7% of women older than 30 who had a hysterectomy had a Pap test in the last three years. Got that? Hat/Tip to NPR’s Shots blog for pointing out this blistering reaction:

That statistic sent Reuters health and science correspondent Sharon Begley right up the wall. “Angry that 1/3 of US med $$ goes to useless ‘care’? Get ready 2 scream: 60% of women w/hysterectomy keep having Paps,” she yelled on Twitter.

While women may view the mildly invasive Pap test as benign, the CDC suggests thinking again. “Most precancerous lesions detected by Pap testing regress, even without treatment,” the authors say.  “(F)requent testing and overtreatment of women can lead to harm associated with diagnostic procedures including adverse birth outcomes.”

An “adverse birth outcome” doesn’t sound very benign to me.

To be fair, the CDC notes that the rate of women being screened inappropriately has declined since 2000. But, then there’s the women who need to be screened but aren’t. In women ages 22-30, the number who said they have never had a Pap test increased from 6.6% in 2000 to 9.0% in 2010. As the CDC notes, “Women not receiving recommended screening and followup are at increased risk for cervical cancer mortality. Underscreening among women with less education, no usual source of health care, and no health-care coverage is well-documented and a persistent cause of health disparities.”

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