How will the new pap test guidelines affect you?

Any questions?

Last week the United States Preventative Task Force changed their recommendation on how frequent women should have a pap test performed. The pap test (or pap smear) detects changes in the cells of your cervix that if left untreated, may or may not develop into cervical cancer. Previously many doctors recommended women have one annually or within a two year span in order to catch any signs of cancer at it's earliest stages. Three other organizations, the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP), were all also in agreement with these new guidelines.

The main reasoning behind these new recommendations stems from clinical trials and research done leading them to conclude frequent examinations may actually be more harmful and invasive than helpful. There is a higher likelihood of false-positives, or the test saying you are positive, when in fact you are really negative. It's also well known that for many young women, HPV (human papillomavirus) the virus associated with cervical cancer, often resolves on its own without further intervention needed. The abnormal cells that can develop into cervical cancer typically take 10+ years to develop into full blown symptoms.

Here are the new guidelines broken down by age group:

21 years old and younger
Screening to begin at 21 years of age. Pap testing alone should be done every three years. No testing before the age of 21, regardless of sexual history.  No HPV testing is needed unless the pap test comes back with an abnormal result.

30-65 years of age
Previously it was preferred that you have a pap test along with the HPV test performed at the same time annually. Both can be done every 5 years, or the pap test alone every 3 years.

Over 65 years of age
If  you have had no abnormal screenings within the past 10 years, then you do not need to be screened for cervical cancer. If you have a history of abnormal screenings, then testing will continue for an additional 20 years.

Keep in mind 
These recommendations apply to all women with a cervix, regardless of their sexual history that do not show any signs or symptoms of developing cervical cancer. Also, those with the  HPV vaccine, still need to follow the recommendations listed above according to their age group. If you have had a hysterectomy (where uterus and cervix were removed) with no history of cervical cancer or pre-cancer, then no screening is needed.

Questions still unanswered

• How will this affect future insurance coverage?
• If you or your doctor decide you need one before the 5 year period, will insurance automatically cover it?
• Many patients don't like going to get their annual checkup in the first place, how will these new recommendations affect patient compliance? For many women, their gynecologist is also their primary care physician, so in addition to pap testing, other routine testing including blood work, cholesterol screening and blood pressure are also performed. 
• Unfortunately there is still a huge part of the US population that does not know what cervical cancer or HPV is (even though previous studies indicate 80% of the US population will have had the virus by the time they reach 50 years of age), or how dangerous cervical cancer can be. Nor do many know there is a vaccine available for women and men. What efforts will be made to ensure they understand these new recommendations?
• Will future studies tailor HPV testing recommendations based on an individuals risk ?

Editor's Note: These questions left unanswered do not indicate a specific opinion towards the new recommendations one way or another. They are merely posed with the hopes of sparking further conversation, to help increase public awareness and perhaps let other experts weigh in with their own professional opinion.