For the second time this week, a major U.S. medical panel has revised recommendations for a key test that millions of American women use to detect cancer.
On Monday, it was mammograms. Today, it's Pap tests.
The American College of Obstetricians and Gynecologists says that women no longer need annual cervical cancer screenings. It also says women can now wait until they're 21 to get their first Pap test, instead of getting one after they've become sexually active.
"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," said Dr. Alan G. Waxman of the University of New Mexico, who headed the American College's guideline revision.
"A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful," he added.
National cervical cancer rates have fallen more than 50 percent in the past 30 years due to the widespread use of the Pap test, the guidelines stated. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006.
Additionally, the new guidelines say moving the minimum screening age to 21 will help avoid unnecessary treatment of adolescents. Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21, accounting for only 0.1 percent of cases.
The recommendations come on the heels of new guidelines for breast cancer screenings issued Monday by the U.S. Preventive Services Task Force, which say that most women can wait until they're 50 to have their first mammogram, and then have one every other year. Groups such as the American Cancer Society have long recommended starting annual mammograms at age 40.
Federal health officials have not yet responded to the new cervical cancer screening guidelines, although U.S. Health and Human Services Secretary Kathleen Sebelius said Wednesday that government insurance programs would continue to cover routine mammograms for women starting at age 40.
What's clear, though, is that the new Pap test guidelines will add fuel to notions that government is too involved in medical decisionmaking. "Let the rationing begin," Rep. Dave Camp of Michigan, the ranking Republican on the House Ways and Means Committee, said in the New York Times after new mammogram guidelines were announced.
It's also likely that changes will add more uncertainty for the millions of women who have faithfully had Pap tests and mammograms for years.
"Confusion is the rule of the day, until the dust can settle on these recommendations," said Dr. Robert Yelverton, chief medical officer for Women's Care Florida, a Tampa-based network of more than 100 obstetricians. "There's confusion not only with patients, but with doctors as well."
No quick changes
Currently, most women in Florida get screened for both cancers. More than 82 percent of women 18 and older reported having had a Pap test within the last three years; and 78 percent of those 40 and older reported having had a mammogram within the last two years, according to the Henry J. Kaiser Family Foundation.
Yelverton doesn't expect any quick changes in policy, either from doctors or health insurance plans. "Doctors are slow to make changes until they're darned sure," he said.
Florida is one of 49 states that require insurance policies to cover mammograms beginning at age 40; there's no coverage requirement here for Pap tests.
Aetna spokesman Ethan Slavin said the insurance company is reviewing the new breast cancer screening recommendations, but he wasn't certain whether it also would review the new Pap guidelines. Meantime, Aetna's current coverage of annual mammograms beginning at age 40 will remain in effect.
Dana Williams, a 32-year-old mother of two from Tampa, said she gets a Pap test every year. She doesn't think the new guidelines are a good idea.
"Let's face it, most kids have sex before they're 21," Williams said. "So with the new recommendations, some might have to wait four to five years to find out whether they have issues."
Williams says she would trust whatever her doctor recommended on screenings.
Yelverton thinks that's a good idea. "Women should talk to a physician they trust, who has their interests in mind."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.