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How Often Should Pap Smears Be Obtained?

We probably can perform Pap smears safely at 3-year intervals in women who are at low-risk for cervical cancer and who have had previous negative Pap smear results.

Guidelines suggest that Pap smears are required only at 3-year intervals in women who are at low risk for developing cervical cancer and who have had previous negative test results (Journal Watch Feb 14 2003). However, little information exists about excess risk that night be associated with screening at less than yearly intervals. To address this issue, these authors performed a retrospective analysis using data from 938,000 women in a U.S. screening program for low-income women.

The investigators estimated risk for cancer within 3 years of 1 or more negative Pap smear results. If screening were performed every year for 3 years, estimated risk for cervical cancer among women with 3 or more previous negative Pap smear results would be 2 per 100,000 in women who are age 30-44, 1 per 100,000 in those who are 45-59, and 1 per 100,000 in women who are 60-64. If screening were performed just once, at 3 years after the last negative test, risks would increase to 5 per 100,000 in women who are 30-44 and to 2 per 100,000 in those who are 45-59. Overall, screening that is performed once, at 3 years after 3 negative tests in women who are 30-64, would be associated with an excess risk for cervical cancer of 3 per 100,000.

Comment: Although women who were included in the database might not represent a typical low-risk population, and errors might be present in the estimates, this analysis provides further evidence that we can safely reduce the frequency of Pap smears in women with previous negative tests who are at low risk.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine November 7, 2003

Citation(s):

Sawaya GF et al. Risk of cervical cancer associated with extending the interval between cervical-cancer screenings. N Engl J Med 2003 Oct 16; 349:1501-9.

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