Ethics in Medicine

Fewer Papsmears Needed

Kristen Sparrow • March 22, 2012

I offer this up as part of an emerging trend in the prevention world. It seems that there is a dawning realization that more treatment, more intervention, does not always lead to better outcomes. It might shock many patients to realize that, for example, HPV (human papilloma virus) is eliminated in most cases by the patient’s own immune system and won’t cause any problems. Just as some breast cancers are small and will go away and the treatment might be worse than any outcome of letting the cancers be. This is a “hard sell” after so many years of admonishing people to get screened for all sorts of conditions. More on my practice, here.

March 14, 2012, 5:58 pm
New Guidelines Advise Less Frequent Pap Smears
The annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.
In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer…
“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”
Cost is not a factor in the task force recommendations. Instead, its members focus on the effectiveness of a screening test to reduce cancer deaths, balanced against the potential harms that accompany the screening. The worry about frequent Pap smear screening is that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk for pregnancy complications in the future, like preterm labor and low-birth-weight infants…
Finally, the group also recommends against regular HPV screening for anyone under 30. In 2003, the task force said it did not have enough evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus will eventually eliminate the virus without any intervention.
“HPV in women under 30 is highly prevalent but also highly transient,” Dr. Nicholson said. “Women under 30 may get infected with HPV, but they have a high likelihood of clearing that infection on their own, and it not causing any long-term change to their cervical tissue.”