Don't perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease.
Sources: US Preventive Services Task Force (USPSTF) (for hysterectomy), American College of Obstetrics and Gynecology (ACOG) (for age)
For Your Patients
Clinical Preventive Service Recommendation
In a 2012 report, the U.S. Preventive Services Task Force (USPSTF) reviewed research published since 2003 that evaluated liquid-based cytology and human papillomavirus (HPV) testing.(1) The USPSTF also commissioned researchers to develop a computer model to calculate the frequency of cervical cancer screening and the ages at which to begin and end this screening. The USPSTF issued the following recommendation statements (1):
The excerpt below is from USPTF summary statement(www.uspreventiveservicestaskforce.org):
“Screening with cervical cytology or HPV testing can lead to physical and emotional harms. Abnormal test results can lead to more frequent testing and invasive diagnostic procedures, such as colposcopy and cervical biopsy. Evidence from randomized, controlled trials and observational studies indicates that harms from these diagnostic procedures include vaginal bleeding, pain, infection, and failure to diagnose (due to inadequate sampling). Abnormal screening test results are also associated with increased anxiety and distress.
The harms of treatment also could include risks from the treatment procedure (such as cold-knife conization and loop excision) which are associated with adverse pregnancy outcomes, such as preterm delivery, that can lead to low birth weight in infants and perinatal death. Evidence is convincing that many precancerous cervical lesions will regress and that other lesions are so slow-growing that they will not become clinically important over a woman's lifetime; identification and treatment of these lesions constitute overdiagnosis. It is difficult to estimate the precise magnitude of overdiagnosis associated with any screening or treatment strategy, but it is of concern because it confers no benefit and can lead to unnecessary surveillance, diagnostic tests, and treatments with the associated harms.”
This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. Patients with any specific questions about this recommendation or their individual situation should consult their physician.
The Choosing Wisely®(www.choosingwisely.org) campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation(www.abimfoundation.org) to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.
Learn more about the AAFP support of the Choosing Wisely® campaign.
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