Some of you have asked me about the new pap smear guideline where the starting age is now 21 years old. There are concerns of cervical cancer may be missed in young girls. A study published in November 2012 evaluated this question by reviewing combined data from US cancer registries and SEER program covering 92% of US population. The study found that for women younger than age 40 years, only 1% of cancer is found in women younger than 20 years old. Since we have about 12,000 new cervical cancers each year in the US, the new pap smear guideline will miss about 120 cervical cancer in young girls.
Various organizations (NCCN, American Cancer Society, USPFTF, ACOG, etc) recommend starting pap smear at age 21 (for "average risk" women) knowing that there will be these a few girls missing their cancer diagnosis. Their reasoning is earlier age pap smear may cause more harm and cost with follow up procedures than the benefit of diagnosing these girls of cervical cancer. I have to admit that I have a mixed feeling about this... Intellectually, I understand the concept but emotionally I have difficulty since I have cared for young girls with cervical cancer.
Reference:
- Benard VB, et al. Cervical carcinoma rates among young females in the United States. Obstet Gynecol. 2012; 120:117-23.
- US preventive services task forces. 2012
- Saslow D, et al. CA Cancer J Clin. 2012;127:516-42
Various organizations (NCCN, American Cancer Society, USPFTF, ACOG, etc) recommend starting pap smear at age 21 (for "average risk" women) knowing that there will be these a few girls missing their cancer diagnosis. Their reasoning is earlier age pap smear may cause more harm and cost with follow up procedures than the benefit of diagnosing these girls of cervical cancer. I have to admit that I have a mixed feeling about this... Intellectually, I understand the concept but emotionally I have difficulty since I have cared for young girls with cervical cancer.
Reference:
- Benard VB, et al. Cervical carcinoma rates among young females in the United States. Obstet Gynecol. 2012; 120:117-23.
- US preventive services task forces. 2012
- Saslow D, et al. CA Cancer J Clin. 2012;127:516-42
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