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Health, Beauty & Fashion

No need for pap smear test every year

Just one screening is needed every 3 years, says new US guideline
The Straits Times - March 16, 2012
By: Poon Chian Hui
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No need for pap smear test every year -- TNP FILE PHOTO

SINGAPORE will continue to advise women to go for a cervical cancer screening test at least once every three years even as the United States yesterday changed its guidelines to recommend that the test be restricted to only once every three years.

The change in the recommended frequency of the pap smear test in the US - from at least once to only once every three years - was contained in the new national guidelines issued by the United States Preventive Services Task Force.

With this, The New York Times reported yesterday, the annual pap smear, which has been a cornerstone of women's health for at least 60 years, is now officially a thing of the past.

This is because calling for a pap smear 'at least every three years' had left the door open for annual tests which many women were reluctant to give up.

In Singapore, the current recommendations are for sexually active women of between 25 and 69 years of age to get a pap smear at least once every three years. These will remain for now, the Health Promotion Board told The Straits Times.

Most women in Singapore follow the guidelines. The latest National Health Survey showed that seven in 10 women who should have pap smears have had them, half of them in the last three years, the recommended frequency. Cervical cancer is the seventh most common cancer in women here.

In the US, the process of change in recommendations began in 2009 when some doctors and medical groups, including the American College of Obstetricians and Gynaecologists, began urging less frequent screenings.

Experts in the US said frequent screening means that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk of pregnancy complications in the future, like pre-term labour and low-birth-weight infants.

The new US guidelines, published in the Annals of Internal Medicine, replace recommendations issued in 2003. Apart from frequency of screening, they cover three other key areas: age at which women should begin screening, age at which they should stop, and testing for human papilloma virus, or HPV, which can cause cervical cancer.

Women in America are now advised to begin screening at age 21 regardless of sexual history, and the task force specifically recommended against screening women younger than 21. In 2003, the advice was to start screening within three years of sexual activity, but no later than 21.

The task force also recommended against screening women over 65, as long as they had had adequate prior screening and were not otherwise at high risk of cervical cancer. That advice has not changed since 2003.

Finally, the group also recommended against regular HPV screening for anyone under 30. In 2003, the task force said it did not have evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus eliminate it without any intervention.

In Singapore, the guidelines were last reviewed in February last year to add a clause that women who had received the cervical cancer vaccine should still go for smears at least once every three years, the Health Promotion Board said.

Dr Wong Seng Weng, medical director of The Cancer Centre, pointed out that the new US guidelines appeared to be inching closer to that of Singapore's.

For example, where once they would start screening girls even in their teenage years, they are now setting the limit to 21 - closer to Singapore's recommendation of 25 years old.

Dr Choo Wan Ling, an obstetrician and gynaecologist at the Gleneagles Medical Centre, added that the US may have changed its guidelines in order not to overload its health-care system.

She also said that there was no harm in women going for pap smears more regularly, refuting that they led to false positives, necessitating painful biopsies.

She said the risk of unnecessary biopsies was low here because the standard practice was to do another pap smear in the next three to six months, to ascertain if results were indeed abnormal, before going onto biopsies.

With additional information from The New York Times



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