Making Sense of the Current Annual Well Women Exam Recommendations

4/4/2019

by Dr. Craig McCoy

Much confusion exists today regarding the “annual well woman exam”. Over the past twenty years I have seen tremendous changes in medicine. One such area is cervical screening. To say that it can be confusing at times is an understatement. The “good old days” had us recommending annual pap smears. This was certainly an easy protocol to follow for healthcare providers and patients . We advised women to begin their exams once they became sexually active or by age 18. In time this recommendation has changed practically 360 degrees. We all understand that change sometimes is difficult to adopt. I can certainly attest to that and I have found that some of my older patients have found this change to be challenging as well. We are such creatures of habit.

What has caused such a change? First and foremost is our understanding of what causes cervical cancer as well as how it behaves. With the advent of discovering that the human papilloma virus (HPV) is the causative pathogen in cervical cancer led researchers to understand its natural progression an life cycle. This understanding in association with improved screening techniques has led to our current recommendations.

What we must first understand is that HPV is a virus. Much like the common cold, we depend on our immune system to recognize and eliminate this pathogen from our bodies. When this system breaks down, chronic disease follows. In this case cervical cancer develops.

The U.S Preventive Services Task Force (USPSTF) partnered with the American Cancer Society/American Society for Colposcopy and Cervical Pathology/ American society for Clinical Pathology (ACS/ASCCP/ASCP) to develop guidelines for current cervical screening. These societies reviewed the current literature and developed the model for screen that we have today. This model is predicated on evidence based medicine. Medicine is evolving away from common ideology to a more reliable and trusted method.

Their first recommendation is against screening women less than age 21 years of age regardless of the age of first sexual encounter or other risk factors. Why is this you may ask? It was found that the immune systems for women less than 21 is typically strong enough to recognize and eliminate the HPV virus. Screening women in this age group only resulted in unnecessary tests and procedures.

Women ages 21-29 should be screened every three years as long as each pap smear is normal. Once an abnormality is identified a different protocol is recommended and is beyond the scope of this article.

Women ages 30-65 should have cervical screening every 3 years. Those wishing to extend this interval to 5 years may do so if HPV testing is added.

Women greater than age 65 who have had adequate cervical screenings in the past with no evidence of prior high grade lesions do not require screening.

One situation that I often get asked about are those who have had a hysterectomy. If there is no history of a high grade lesion on a previous pap smear then annual screening exams are not necessary.

The last recommendation by the committee involves women who have had the HPV vaccine. They still need to be screened in the same manner as women who have not had the vaccine.

Why such a dramatic change in the recommendations? Most cervical cancers are slow growing. It is typically diagnosed in women who have never been screened or those who extend their interval beyond 5 years. The current recommendations are based on a benefit and harm statute. Yearly screening exams were found to not significantly reduce the cervical cancer detection rate however it did result in unnecessary tests and procedures.

Although it is very tempting to think that now annual visits are not necessary, this is highly discouraged. There are a multitude of other health issues that need to be addressed annually. Be sure take time to schedule annual well women exam. The time saved performing a pap smear will allow for other issues more pertinent for your age to be addressed.

If you would like to schedule your annual well woman exam or have questions for Dr. McCoy, he is located at 1513 Union Ave, Suite 1600 in Moberly, Missouri. The clinic phone number is (660) 269-8752.

Back