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Teens May Not Benefit from Pap Tests
Date:7/28/2009

British study supports raising age for screening, which U.S. is pondering,,

TUESDAY, July 28 (HealthDay News) -- A British study adds evidence to support a growing movement to raise the age at which American women should start Pap screening to detect cervical cancer.

In England, the recommended age at which a woman should first have a Pap test was recently raised to 25. In the United States, however, women are told to get regular Pap smears within three years of their first sexual intercourse or at age 21, whichever comes first.

But changes are being considered by the U.S. organizations responsible for Pap test recommendations, said Debbie Saslow, director for breast and gynecological cancer at the American Cancer Society, one of those organizations.

She said that there's a broad-based feeling that the age for first testing should be raised to 21. "What we find is that screening is not very helpful in teenagers, even if we are finding cancer at an early age," Saslow said.

The British study "did show, as we have found many times, that low-grade lesions go away by themselves more often in younger women," she said.

The study, in fact, was undertaken because many British experts believed that a pap test followed by aggressive treatment of moderate cancerous changes in the cervix did more harm than good in women younger than 25. In Scotland, Wales and Northern Ireland, Pap tests are still offered to women aged 20 to 24.

The researchers, from Queen Mary College in London, compared 4,012 women who were diagnosed with cervical cancer between 1990 and 2008 with a matched group of 7,889 women who did not have the disease. All women were 20 to 69 years old and lived in the same areas.

Three papers published online Tuesday in the journal BMJ reported on three aspects of the study.

The first found no difference in outcomes when young women whose Pap smears showed abnormal cells were either told to come back later for another test or were assigned to have colposcopy, a detailed examination of the cervix to detect precancerous cells.

Pap test screening of women aged 22 to 24 did not reduce the incidence of cervical cancer over the next five years, the researchers reported. Screening of women 30 to 37 years old, however, was associated with a reduction of cervical cancer risk over the next five years of between 43 percent and 60 percent.

The second report found no difference in outcome between young women who underwent colposcopy and had loop excision, which is surgery to remove abnormal cells, and those who did not have the procedure. More physical problems, such as bleeding, occurred in the women who had the surgery.

And the third report, a cost-benefit analysis, found that immediate colposcopy was not more cost-effective than what the researchers called watchful waiting.

A major lesson of the study is that "there is not much to be gained in being aggressive" in dealing with minor abnormalities found in a Pap test of a younger woman, said Eduardo Franco, a professor of epidemiology and oncology at McGill University in Montreal, who co-authored an accompanying editorial.

"When you look at the balance of benefits and harms, surveillance does as well," Franco said.

But the decision on screening and follow-up will continue to be made country by country, he said. "Each society decides on its own threshold of maximum benefit," Franco noted.

The U.S. Preventive Services Task Force, a government agency, is expected to issue new age guidelines in the near future for Pap tests, Saslow said, as is the American College of Obstetrics and Gynecology. New recommendations will be made by the American Cancer Society "a year from now," she said.

If the age were to be raised, the United States would move closer to European guidelines, although the difference would still be substantial.

"The Europeans think we are crazy for screening teenagers," Saslow said.

More information

The U.S. Centers for Disease Control and Prevention has more on current U.S. screening recommendations for Pap tests.



SOURCES: Debbie Saslow, Ph.D., director, breast and gynecological cancer, American Cancer Society, Atlanta; Eduardo Franco, Dr.P.H., professor, epidemiology and oncology, McGill University, Montreal; July 29, 2009, BMJ, online


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