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February 6, 2005
How frequently should cervical cancer screening be done?

How often should women be screened for cervical cancer?  We had a 33 year old patient come in this week for her annual pap and pelvic exam.  She is not currently and has never been sexually active.  She has never had an abnormal pap with her last one being 1/2004.  We told her that if her last two paps were normal, she really only needed to get them every 2-3 years instead of annually.  However, she decided to go ahead and have it done since she was already in our office and since she she'd had them annually in the past.

This interaction caused me to wonder about women's perceptions of pap smears and why this patient chose to go ahead and have it done even though we spent a fair amount of time explaining to her why it was unnecessary.   One study looking at women's perceptions about pap smears showed that many women are not open to the idea of reducing the frequency of their annual pap smears.  Some women are distrustful of the motivation behind decreasing the frequency of pap smears.  Others have concerns about the accuracy of the test.

Let's look at the numbers. 93% of American women over age 21 have had at least one pap smear in their lifetime.  Of women with no history of abnormal smears.  55% have an annual pap.  17% are screened very two years, and 16% are screened every 3 years. 

Take a look at ACOG's recommendations for cervical cancer screening.  Many women still want to have an annual pap smear regardless of current recommendations.  It is important educate them about current recommendations and address their fears and concerns about no longer having annual pap smears if they are unnecessary.

Posted At : 7:52 PM. | Link | Rotation 3 04-05 | Comments (7)

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Comments

Thanks for the data on screening and Paps. Espescially right before the test. Its amazing to me what some patients won't do (blood pressure meds, lipid lowering, excercising, etc.). But they will hold on to annual paps, weird.

Posted By Adam Frederick / Posted At 2/7/05 9:35 AM

this was a very useful post laura. great topic. if someone is not sexually active, do they still need to have then annual? or is just one normal one fine. given they without sexual activity, they are not increasing their risks- why would they need annual ones. also, i wonder what is the risk one is adding to themselves if they do not get screened if they are not active?

Posted By Fazila Lalani / Posted At 2/8/05 8:09 AM

I would think the opposite was the case, that is women refusing frequent "invasion of privacy" to gat PAP tests. So, I was wondering if this patient was exposed to someone who had cervical cancer which could have been identified by regular PAP. Hence, her insistence on getting one. Nice job

Posted By Rachel Egbujor / Posted At 2/8/05 8:56 AM

I guess I still have a lot to learn about women. I know most men would do anything to avoid their rectal exams. It's unfortunate that evidence doesn't seem to matter to some patients, and even to some providers.

Posted By Ram Chanamolu / Posted At 2/8/05 9:23 PM

It's funny since I've 2 women have not had PAP smears done in the last 10-15 years and they would have liked to avoided this year's as well. I think the reluctance of women giving up annual PAPs probably points towards the tendency of women to be more proactive in their medical care than men.

Posted By So Yun Park / Posted At 2/9/05 10:27 PM

Laura, I think its' vital to properly gauge the perceptions and motivations of patients for getting any kinds of screening test done. The sensitivity of Paps in detecting Early cervical cancer is well documented, but the question is whether ACOG recommendations will really change the life saving perception of paps. Science backed by research was the one to enforce the belief that Paps are essential and every women must be getting them. Additionally we are bombarded with heroic stories of how a simple pap test saves someones life. So I'm sure it will take time to relieve the tension and apprehension associated with not doing them as frequently. Great job in tackling this issue Laura....

Posted By Rishi Kakar / Posted At 2/9/05 10:34 PM

Laura this is great. I often wonder why my FP doc demands that every pt have ANNUAL paps. I questioned her about it knowing the recommendations.

Posted By Michael Van Vliet / Posted At 2/10/05 9:22 PM