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
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