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New guidelines for cervical cancer screening

By Patricia Nicholson

Regular Pap screening is a crucial defence against cervical cancer. A Pap test can detect early, precancerous changes to cervical cells that are caused by the human papillomavirus (HPV), which is spread through sexual contact.

Cancer Care Ontario recently updated its cervical cancer screening guidelines. The new guidelines advise that women in Ontario who are, or have ever been, sexually active should have a Pap test every three years from age 21 through 70. After age 70, women who have had three normal Pap tests in the preceding 10 years can stop screening.

Women who have never been sexually active do not require screening, but the definition of sexual activity is very broad, and includes not only intercourse but also oral and digital activity with a partner of any gender.

The new guidelines aren’t a radical change from the old guidelines, says Dr. Sheila Dunn, research director at the Family Practice Health Centre at Women’s College Hospital. “But I think the messaging is pretty simple: you don’t screen before 21 and you screen every three years until 70.”

Under the new guidelines, teenagers will not be screened, regardless of their sexual history.

“The reason that’s really important is that changes on Pap smears are very frequent as women become sexually active and they get infected with HPV,” says Dr. Dunn. However, in most of those young women, the infection will clear on its own. But until it clears, those women may show HPV-related changes on their Pap tests, which can lead to unnecessary treatment.

“Finding an abnormal pap smear in a very young woman often will take her down the path of having colposcopy and possibly treatment with excision of areas of the cervix or laser treatment, and we now know that not only is that not necessary in almost all cases – particularly in very young women – but it also has implications in terms of negative outcomes for pregnancy such as preterm labour,” Dr. Dunn explains. “It’s not a totally benign treatment.”

The goal of the new guidelines is to prevent unnecessary treatment while still identifying women who do need treatment. Research has shown that there is no benefit to screening women under age 21.

Although women under 21 do not need a Pap test, screening for sexually transmitted infections (STIs), particularly Chlamydia, is still recommended for sexually active women under age 25.



This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Sept. 5, 2012

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