Recent recommendations by the Canadian Task Force to stop pap testing women under the age of 25 have not been sitting well with the Society of Obstetricians and Gynecologists. The numbers of women undergoing cervical cancer screening have been steadily declining in recent years, and the numbers are poised to drop even further given the new recommendations to stop screening women under 25. Ob-gyns are beginning to fight back by claiming young women are being placed at risk by not screening, but the evidence gathered by the task force strongly suggests otherwise.
The task force has utilized research revealing that more harm than good is being caused by screening women under the age of 25. Cervical cancer is extremely rare in young women, while at the same time the pap test used to screen for cervical cancer has a high rate of inaccuracy – especially in young women. When a young woman receives a positive pap test result, and in most cases this is a false alarm, she is often sent for colposcopy/biopsy and this is where damage to her cervix can occur. Young women with damaged cervix’s due to colposcopy/biopsy often have difficulty with pregnancy and are at greater risk of giving birth to premature/stillborn babies.
The task force has also compared cervical cancer mortality trends amongst young women in other countries that screen women less frequently, such as Finland. In Finland women are not screened for cervical cancer until age 30, and then afterwards are only screened once every 5 years. In spite of far less frequent screening beginning at a later age, rates of cervical cancer in Finland are comparable to other countries which screen far more often and at younger ages. For example, research from the Netherlands states that “Cross-country studies like ours are natural experiments that can produce insights not easily obtained from other types of study. The cervical cancer screening system in the Netherlands seems to have been as effective as the U.S. system but used much less screening.” http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00652.x/abstract The conclusion from the research study was that the majority of countries are needlessly over screening.
The battle between the ob-gyns and the task force is all well and good, but there is still a lack of informed consent being offered to women in regards to pap tests/vaginal exams. Each individual should be offered truthful information and be given a choice to screen/what age to screen for cervical cancer – and this would render moot any battle over age of screening.
Also worth noting here is the fact that there has been an absence of complaints made in regards to the task force’s recommendation to cease and desist screening women over the age of 70 – even though cervical cancer, while still rare, is far more common amongst older women than it is amongst young women. “Women ages 65 and older have a cervical cancer incidence rate of 16.8 per 100,000, compared to 7.4 for women younger than 65.” http://seniorhealth.about.com/cs/womenshealth/a/cerv_cancer.htm
The reasons for the lack of concern related to the task force’s recommendation to stop screening older women with greater risk of cervical cancer are unclear.