More women adhering to Pap test recommendations

Even after having a total hysterectomy, 60% of women continue to get Papanicolaou (Pap) testing, according to a study in the January 4 Morbidity and Mortality Weekly Report. A second study in the latest MMWR reported that women 30 years or younger are getting screened consistent with more recent national recommendations.

The U.S. Preventive Services Task Force, American Cancer Society, and American College of Obstetricians and Gynecologists recommended in 2012 that starting at 21 years of age, women should begin Pap test screening every 3 years; they should not be screened annually. The organizations also stated that Pap screening is unnecessary for (1) most women who have had a total hysterectomy (i.e., removal of the uterus and uterine cervix) for noncancerous reasons and (2) women 65 years or older who have had normal test results for several years.

Data from CDC’s Behavior Risk Factor Surveillance System, from 2000 through 2010, were used in both MMWR studies. The researchers reported that screening has become more consistent with current cervical cancer screening recommendations, as follows:

• The proportion of women aged 18 to 21 years who reported never receiving Pap testing increased from 23.6% in 2000 to 47.5% in 2010. (Screening is not recommended for women younger than 21 years.)
• Recent Pap testing (within 3 years) decreased from 73.5% in 2000 to 64.5% among women 30 years or older without a hysterectomy. A decline in testing among women 65 years or older was the primary reason for the overall decrease.
• Among women 30 years or older who had undergone a hysterectomy, Pap testing decreased from 73.3% in 2000 to 58.7% in 2010.

However, contrary to recommendations, the researchers also reported the following:

• Among women aged 22 to 30 years, the proportion who had not been screened increased from 6.5% in 2000 to 9.0% in 2010.
• The likelihood of not receiving a Pap test within the previous 3 years increased for women 30 to 64 years of age who did not have health insurance and had not had a hysterectomy (from 74.4% in 2000 to 68.7% in 2010).

Keisha Houston, DrPh, Epidemic Intelligence Service officer at the CDC Division of Cancer Prevention Control, stated in a news release: “The good news is we are focusing our public health efforts on women at highest risk, while decreasing screening for women under age 21, when cervical cancer is rare and screening is not recommended."

"We need to remain vigilant and increase screening among women who would benefit most from this preventive service,” added Houston.

Of note, as a result of the Affordable Care Act, preventive services such as cervical cancer screening are now covered by many private health plans and Medicare with no patient copays or other out-of-pocket costs.

More information is available at CDC's cervical cancer page and in the agency's chart showing cervical cancer screening guidelines.