Reducing Pap Test Frequency May Be a Hard Sell

Article excerpt

Physicians could be hard-pressed to convince their female patients that some don't need an annual Pap smear, a study has shown.

In a series of eight focus group sessions meant to gauge women's perceptions about risk-based cervical cancer screening, nearly all of the 68 women interviewed were firmly set against reducing the frequency of Pap tests, according to Dr. Mindy Smith and her colleagues at Michigan State University, East Lansing, in the Periodic Abstinence From Pap (PAP) Smear Study: Women's Perceptions of Pap Smear Screening.

"The habit of having an annual visit to a clinician for a Pap smear appears to be firmly entrenched" and viewed as an integral part of a women's health care. It is a habit that has been socialized over many years and will likely be difficult to change, the investigators wrote (Ann. Fam. Med. 1[4]:203-08, 2003).

Recent studies have shown that women who undergo annual Pap smears are not at significantly lower risk for invasive cervical cancer than women who are tested every 3-5 years. In fact, combined data from a series of eight studies of more than 1.8 million women showed the cumulative incidence of cervical cancer among women who received annual screening to be only 2.7% lower than that of women screened at 3-year intervals.

Accordingly, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force have recently changed their Pap smear frequency recommendations. They now advocate screening every 2-3 years for low-risk women following three consecutive normal Pap results.

The reluctance among focus-group participants to accept less frequent screening recommendations was most often rooted in the women's beliefs that annual Pap tests have played a critical role in reducing the incidence of invasive cervical cancer, and thus it's best not to risk changing something that works.

Some participants expressed concern that Pap tests are not always accurate and possible oversights would be easier caught through annual screenings, and some felt the new recommendations were less a product of scientific evidence than of insurance-industry pressure to cut costs. …

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