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Enhanced understanding of cervical cancer prompts changes to screening guidelines

“Regular Pap tests can prevent 90 per cent of deaths from cervical cancer,” said Dr. Robert Grimshaw, Medical Director, CCNS’s Cervical Cancer Prevention Program. “It’s a strong selling point for the benefit of regular screening for cervical cancer. The revised guidelines underscore the value of regular screening while reflecting increased knowledge of how cervical cancer develops and a better understanding of the benefits and harms of screening.”

The three changes to the guidelines include: the age that women should start having Pap tests, the age they should stop having Pap tests and how often they should have them.

The revised guidelines recommend:
-Women under 20 years old do not need a regular Pap test.

- Sexually active women should start having regular Pap tests at age 21 or within three years of first vaginal sexual activity, whichever comes last. Once a person begins having Pap tests, they should continue to have them every three years. Women who have never had sex do not need Pap tests.

-Women over the age of 70 who have had three normal Pap tests in a row no longer need to be screened. Those over the age of 70 who have not had three normal Pap tests in a row should continue having Pap tests every three years until they do.

“Pap tests look for pre-cancerous cells in the cervix befordr_ge there are any warning signs or symptoms in people who are at average risk for the disease,” said Dr. Grimshaw. “All women who have ever had sex and all who have never been treated for cervical cancer or a pre-cancer fit into the average risk category. Because cervical cancer is caused by the sexually transmitted human papilloma virus (HPV), women who have never had sex do not need a Pap test.”

Women who have been treated for pre-cancer or cancer and those who have a weakened immune system due to HIV AIDS, for example, are at increased risk. These women should speak with their family doctor or health care provider about how often they need a Pap test.”

The recommendation to begin screening sexually active women only at age 21 will reduce the number of false positive results and un-necessary clinical follow-up as well as possible risks associated with the follow-up care.

“Young women have strong immune systems,” said Dr. Grimshaw. “We now know that cervical dysplasia in young women is caused by the HPV infection and almost always clears up on its own without treatment. Treatment can be stressful and uncomfortable, but more importantly it can lead to future risk such as increasing the woman’s chance of having a premature delivery. We believe the recommendation to begin Pap testing sexually active women at 21 is a good balance in our efforts to weigh risk versus benefit.”

Dr. Grimshaw said it is likely that the guidelines for cervical cancer screening will change again when more HPV vaccination data from the school-based immunization program, introduced in 2007, has been collected and analyzed.

CCNS encourages women to talk with their family doctor or health care provider about what these revised guidelines mean for them.

Any woman wanting a copy of her Pap test history may call the Cervical Cancer Prevention Program at 1-888-480-8588.

The Nova Scotia guidelines were adapted from national cervical screening guidelines revised earlier this year by the Canadian Task Force on Preventive Health Care. Nova Scotia experts, including representatives from Doctors Nova Scotia and considered the strength of the evidence as they updated the Nova Scotia guidelines.

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