Philadelphia, PA -- At a news conference today, a leading expert in cervical cancer screening from The American College of Obstetricians and Gynecologists (ACOG) called for a better public understanding of recent clinical guidelines addressing how and how often to screen for cervical cancer.

"It is critical that both women and their physicians be aware of the implications surrounding the changes in screening guidelines and how the changes will affect them," commented Kenneth L. Noller, MD, chair of the department of obstetrics and gynecology at Tufts-New England Medical Center and the Louis E. Phaneuf professor and chair, department of ob-gyn at Tufts University School of Medicine in Boston, MA. Dr. Noller noted that an estimated 10,520 new cases of invasive cervical cancer will be diagnosed in the United States in 2004 and about 3,900 US women will die of the disease.

In August 2003, ACOG issued its most comprehensive revision of cervical cancer screening (also called cervical cytology or the Pap test) guidelines in more than a decade. Based on the latest scientific findings, the new recommendations focus on age and a prior history of abnormal cytology. For many women age 30 or older, extending cervical cancer screening from once a year to once every two or three years is a safe option. The revised ACOG guidelines also note that screening can begin later than previously recommended. In addition to a woman's age, her previous test results and other health issues are among other factors that determine frequency of screening.

(A table summarizing ACOG's cervical cancer screening recommendations.)

First Screen	Women Up to Age 30	Women Age 30 and Older
About three years after first sexual intercourse or by age 21, whichever comes first.	Annual cervical cytology testing.	Three screening options: Women who have had three negative results on annual Pap tests can be rescreened with cytology alone every two to three years. Annual cervical cytology testing. Cytology with the addition of an HPV-DNA test. If both the cervical cytology and the DNA test are negative, rescreening should occur no sooner than three years.
*Women of any age who are immunocompromised, are infected with HIV, or were exposed in utero to DES should be screened annually.

Most women who have had a hysterectomy with removal of the cervix for benign reasons may discontinue routine cytology testing. However, women who have had such a hysterectomy but who have a history of abnormal cell growth (classified as CIN 2 or 3) should be screened annually until they have three consecutive, negative vaginal cytology tests; then they can discontinue routine screening.

"We must also emphasize to our patients that a Pap test and pelvic examination are not one and the same," said ACOG's Vice President for Practice Activities, Stanley Zinberg, MD. All women age 18 or older need annual gynecologic examinations, including a pelvic examination, as do sexually active adolescents younger than age 18. The well-woman visit is a key part of preventive care; it includes a discussion of the patient's health history and reproductive health care needs, a physical examination, including a weight and blood pressure check, a clinical breast examination, and various tests depending on a woman's age and risk factors for disease.

"Women today have grown accustomed to scheduling their annual Pap test. It's as much a ritual with them as routine dental checkups or a mammogram," said Dr. Noller. "The impact of these changes on the clinical practices of ob-gyns is quite significant. In fact, reducing the frequency of Pap tests may be met with resistance by many women. It's up to ob-gyns to serve as educators about the new screening recommendations," he added.

Dr. Noller also discussed a new approach to cervical cancer screening for women age 30 and older that was approved by the Food and Drug Administration in March 2003. In this method, a DNA test for high-risk subtypes of the human papillomavirus (HPV, which is associated with cervical cancer) is combined with cervical cytology. "This combined testing is appropriate only for women at age 30 and older because HPV is quite common in younger women but usually clears up on its own in one to two years," he said.

According to ACOG, regardless of a woman's recommended testing interval, data indicate that both liquid-based and conventional methods of cervical cytology are acceptable for use in testing.

"These guidelines are a significant step forward in achieving our ultimate goal—the elimination of cervical cancer as a leading cause of death among women. Prevention and early detection are the keys to reducing deaths from cervical cancer, and these guidelines provide an important new framework for both physicians and women," Dr. Zinberg said. The recent ACOG recommendations largely conform to guidelines issued by the American Cancer Society and the US Preventive Services Task Force.

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