Women Want Annual Pap Smear Despite Guidelines

Most women want annual Pap smears (search) even when their doctors say they’re not necessary.

In a recent nationwide survey, more than two-thirds of the women said they would want a yearly Pap smear even if their doctor recommended less frequent testing. A similar percentage planned to continue getting the test for the rest of their lives.

Current guidelines call for screening most women over age 30 every two or three years if they have a recent history of three or more consecutive normal Pap smears. Cervical cancer (search) screening is generally not recommended for women over 65 or 70 or for women who have had hysterectomies.

More frequent screening isn’t just costly, an expert tells WebMD. It also increases the likelihood that a patient will be harmed due to the large number of unnecessary biopsies that result from false-positive tests.

“There is little question in my mind that over-screening is harmful,” San Francisco ob-gyn George F. Sawaya, MD, tells WebMD. “Many patients think the move away from annual testing is driven by cost, but it is really about trying to minimize harm.”

Skepticism High

Only about 40 percent of the women who took part in the survey knew that annual cervical cancer screening was no longer routinely recommended. When told this, half the women questioned said they thought the change was driven by economic considerations.

“We found a high degree of skepticism among the women about the motivation for the move toward less frequent screening,” researcher Brenda Sirovich, MD, tells WebMD. Such concerns were strongly predictive of a refusal to accept less-than-annual screening, she adds.

“Even among women who believed scientific evidence, and not cost, was responsible for the guideline changes, almost half said they still wanted a yearly Pap test.”

Sirovich says she was most surprised to find that women who had undergone hysterectomies and therefore had little or no risk for developing cervical cancer were just as likely to continue annual screening.

“It is hard to say what is going on there,” she says. “This test has been around for 60 years and doctors have spent much of that time trying to convince women to have [a Pap smear]. It may be that many doctors fear that they would undermine their patients’ trust if patients are now told that they don’t need it or don’t need it as often.”

Getting Women in the Door

In an editorial accompanying the research, Sawaya wrote that many doctors may also be reluctant to abandon annual Pap smears because it gets women to come in for other health services. He tells WebMD that it is common for doctors to require a Pap test before prescribing oral birth control, even though the practice is not recommended.

Sawaya says convincing women that an annual Pap smear may do them more harm than good is likely to be a hard sell. But it is important, he adds, to maximize the benefits and minimize the harm of cervical cancer screening.

“Right now, we do a very poor job of explaining the down side of screening to low-risk women,” he says.

By Salynn Boyles, reviewed by Michael W. Smith, MD

SOURCES: Sirovich, B. The American Journal of Medicine, February 2005; vol 118: pp 151-158. Brenda E. Sirovich, MD, MS, staff physician and research associate, VA Medical Center, White River Junction, V.T.; and assistant professor, Dartmouth College, Hanover, N.H. George F. Sawaya, MD, department of obstetrics, gynecology and reproductive Sciences, University of California, San Francisco. Cervical cancer screening guidelines, American College of Obstetricians and Gynecologists. American Cancer Society; U.S. Preventive Services Task Force.