Reply turned post, not ranting about pap frequency

I want to be Dr. P at The Blog That Ate Manhattan when I grow up. If you like my blog, you should love hers. She has been especially on fire, both with her cooking posts and her women’s health posts. Her blog has been in my sidebar forever. But, I can’t resist linking to her now and then, even when huge women’s health and politics related stories pile one on top of each other and don’t budge me to post.

She wrote about the new American Cancer Society cervical cancer screening recommendations on her blog here. She does an excellent job of breaking them down, and discussing their implications to both patients with different clinical histories and providers. Go read her post, and then I had a reply. Usually my reply – turned – posts are ranty, but this one is just guidelines wonk-y:

Your blog posts are always wonderful, and they have been especially informative and well researched recently. Thanks!

The ACOG / USPSTF recommendations currently say not to do HPV testing under age 30, as far as I know, even if the cytology is abnormal:

Am I correct that the ACS recommendation are slightly different? (Which is not unheard of, they are different when it comes to mammography initiation and frequency, for example.)

If these ACS recommendations accept a higher rate of cervical cancer in the 20 – 29 group, I wonder what the effect of reflexive HPV testing will have on cancer detection in that age group.

What do you think of scheduling annual appointments for bimanual exams and counseling? I think bimanuals are still recommended yearly. How would that work, practically?


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8 responses to “Reply turned post, not ranting about pap frequency

  1. Thanks so much for the shout out, and right back at ya!

    Thought I’d post my reply to your comment here as well.

    Have a great day!


    MomTFH –

    USPSTF recs are for screening, not managing abnormal paps. HPV is not used for screening in the under 30 crowd, but still has a role in triaging abnormal pap smears in women over age 21. (Not in the under age 21 crowd)

    Table 1 in the linked Oncology article is pretty clear on the role of HPV testing in management of abnl paps if you want a good reference. Also check out the ASCCP pap guidelines, which they referenced in the Oncology table.

    ACOG has not come out with new recs, unless I missed something very recent.

    There is no role for screening HPV testing in the under 30 crowd. They all have HPV and almost always will clear it. It would lead to much over diagnosis and over screening if HPV were added to routine screening.

    As to how the annual exam will evolve over time, it will be interesting to see. I don’t know that there is anything magic about a 12 month interval. I do know I do a lot more than pap smears in my annual visits. But we will see.

    Thanks for your comment.



  2. JJ

    Ok, I am wondering about this bit about the under-30 crowd “all has HPV and they will almost always clear it.” I have always been HPV negative, even when under 30.. why is it assumed that everyone under 30 has HPV?

  3. lauredhel

    While many are still doing them out of habit, routine bimanuals aren’t recommended for asymptomatic women here — I haven’t had one for many years. (And have already moved to three-yearly Paps for myself). I see no reason for it, any more than I see a need for pregnant women to have medical fingers stuck in them over and over again, as many obstetricians do. It’s useless as a screening test for ovarian cancer (which is how some doctors justify it). In addition, many women find it an overly invasive test, more so than relatively hands-off speculum examination, and a deterrent to regular Pap and STI screening.

  4. Ariann

    So if I’m not getting a pap smear, not getting a bimanual exam, and can have my regular doctor do a breast exam and the rest of a routine physical, is there any reason I should be seeing a gynecologist every year?

  5. lauredhel

    Ariann: Here in Australia, we find the idea of well women going to gynaecologists rather bemusing!

  6. @lauredhel and @Ariann, when I wrote this post, I thought ACOG was still recommending annual bimanual exams. I checked, and they have withdrawn that guideline. All I can see on their website is a reference to “annual pelvic exams” for women over 21: . I was not saying I necessarily support an annual bimanual exam.

    As for seeing an ob/gyn yearly, I think it really depends. Many people, regardless of the new or old guidelines, seek their gynecological health care from family practitioners or even nurse practitioners or nurse midwives. Some choose to use an ob/gyn as a primary care physician, and do not seek care from any other practitioners, even for general conditions such as high blood pressure. It is definitely not unheard of here to see an ob/gyn for well visits, however.

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