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Reports examine Pap screening guidelines adherence

Thursday January 3, 2013
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Women ages 30 and younger are getting screened in keeping with newer national recommendations, according to a report released by the Centers for Disease Control and Prevention.

In a separate study, however, the CDC reported that 60% of women continue to get Pap tests even after having a total hysterectomy.

In 2012, the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists and American Cancer Society recommended that women should have Pap test screening every three years beginning at age 21, and that women should not be screened annually. The same groups agreed that screening is unnecessary for most women who have had a total hysterectomy for non-cancerous reasons, or for women ages 65 and older with several years of normal test results.

"As we monitor Pap test use among U.S. women, we can make sure that women are being screened in accordance with guidelines, to best maximize the benefits of screening and minimize the harms," Meg Watson, MPH, an epidemiologist with the CDC’s Division of Cancer Prevention and Control, said in a news release.

The researchers for both studies analyzed Pap test survey data from the CDC’s Behavior Risk Factor Surveillance System dating from 2000 through 2010. They found that screening has become more consistent with current cervical cancer screening recommendations in some respects:

• Among women ages 18 to 21, 47.5% reported never having been screened in 2010, compared with 23.6% in 2000. Screening is not recommended for women younger than 21.

• In 2010, recent Pap testing (within three years) dropped among women ages 30 and older without a hysterectomy, to 64.5% from 73.5% in 2000 — primarily because of declines among women ages 65 and older, a group for whom screening is not recommended.

• For women ages 30 and older who’d had a hysterectomy, Pap testing declined from 73.3% in 2000 to 58.7% in 2010.

Other trends run contrary to recommendations:

• Among women ages 22 to 30, 9% had not been screened in 2010, compared with 6.5% in 2000.

• Women ages 30 to 64 who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous three years. The decline was from 74.4% in 2000 to 68.7% in 2010.

"The good news is we are focusing our public health efforts on women at highest risk, while decreasing screening for women under age 21, when cervical cancer is rare and screening is not recommended, said Keisha Houston, DrPh, Epidemic Intelligence Service officer with the CDC’s Division of Cancer Prevention Control. "We need to remain vigilant and increase screening among women who would benefit most from this preventive service."

Because of the Affordable Care Act, many private health plans and Medicare have begun covering certain preventive services, including cervical cancer screening, with no copays or other out-of-pocket costs, according to the news release.

The two studies appear in the Jan. 4 issue of the Morbidity and Mortality Weekly Report and are available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6151a2.htm?s_cid=mm6151a2_w and www.cdc.gov/mmwr/preview/mmwrhtml/mm6151a3.htm?s_cid=mm6151a3_w.

For information about CDC’s efforts in cervical cancer prevention, visit www.cdc.gov/cancer/cervical/index.htm. A PDF with more information about the screening guidelines is available at www.cdc.gov/cancer/cervical/pdf/guidelines.pdf.


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