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http://www.nytimes.com/2002/12/18/health/18CERV.html

Less Screening Urged for Some for Cervix Cancer

By DENISE GRADY

he American Cancer Society has issued new guidelines for cervical cancer screening that will allow some women to skip Pap tests entirely or have them less often.

Among those who do not need Pap tests, the cancer society says, are women who have never had sexual intercourse, women who have had total hysterectomies that included removal of the cervix for reasons other than cancer and women age 70 or older who have had three or more normal Pap test results and no abnormal results in the last 10 years.

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The reason women who have never had intercourse do not need Pap tests is that the vast majority of cervical cancers, from 93 to 100 percent, are caused by a sexually transmitted virus, the human papillomavirus, or HPV. A woman who has not had sexual intercourse is highly unlikely to have contracted the virus.

But the cancer society advises doctors to proceed with caution when it comes to skipping the test, because patients do not always report their sexual experience, particularly those who have been victims of abuse or who fear repercussions if their families find out they have been sexually active.

"You don't want to screen a virgin, but is the woman either not telling, or can't tell?" said Dr. Debbie Saslow, director for breast and gynecologic cancer at the cancer society.

For that reason, the guidelines state that cervical cancer screening should begin about three years after a woman begins having vaginal intercourse, but no later than age 21 if there is any question about the truth.

Then, screening should be done every year with standard Pap tests, or every two years if the doctor uses a newer, more accurate type of Pap test in which the cells scraped from the cervix are suspended in liquid instead of being rubbed directly onto a microscope slide.

At or after age 30, women who have had three normal tests in a row no longer have to be tested every year. They can be screened every two or three years, though more frequent tests may be recommended for women with H.I.V. infection or certain other health problems.

Dr. Saslow said, however, that even a woman who does not need yearly Pap tests will have to see a doctor at least once a year for matters like birth control, sexually transmitted diseases and problems arising from menopause.

The new guidelines, published in the November-December issue of the cancer society's journal CA, were developed to help reduce the number of women who are screened needlessly and get falsely positive or ambiguous results that lead to costly, unneeded and nerve-racking invasive procedures. About 50 million women a year in the United States have Pap tests.

"Close to three million women get abnormal results every year," Dr. Saslow said, "and only 13,000 have cancer."

About half of all cervical cancer cases occur in women who have never been screened, the society said, and an additional 10 percent in women who have gone more than five years without a Pap test. About 4,000 women a year die of the disease.

Earlier guidelines, published in 1988, called for all women to begin having yearly Pap tests at age 18, or earlier if they were already sexually active. After three or more normal results, those guidelines said, the test could be performed less often, at the doctor's discretion.

But Dr. Saslow said that even after the 1988 guidelines were issued, many doctors continued doing yearly Pap tests on women who did not need them, contributing to the false positives and needless follow-up procedures.

She said leading medical groups, including the American College of Obstetricians and Gynecologists, supported the new guidelines.

"We had 40 experts on our panel," Dr. Saslow said. "Then at least a dozen organizations reviewed when we were all done. Nobody came back with any comments that disagreed or questioned our recommendations."

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