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U.S. News

No Pap Smears for Women Under 21: Guidelines

August 6, 2010

Most women should not bother getting a Pap test until they turn 21, according to the American College of Obstetricians and Gynecologists (ACOG). However, certain populations under 21 that still do need screening are detailed in new ACOG guidelines. Exceptions include women with compromised immune systems, since they cannot "fend off viral infections as easily or at all," ACOG said in a release.

"HIV-infected adolescent girls should have cervical cancer screening twice in the first year after their HIV diagnosis and once a year thereafter," ACOG said. "Sexually active adolescents who have weakened immune systems from an organ transplant or because of long-term steroid therapy also should be screened six months apart in the first year after they begin having sex and then continue with annual Pap tests."

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Reader Comments:

Comment by: Eliz52 (Melbourne) Tue., Jan. 11, 2011 at 8:59 pm EST
I have no idea why governments and doctors push pap tests on young women - they risk their health.
In "Cervical cancer screening" in Australian Doctor (2006) Associate Professor Margaret Davy, Director of Gynecology-oncology at the Royal Adelaide Hospital says, "No country has reported any decline in the incidence of or mortality from cervical cancer in women under 30, irrespective of cervical screening. Many countries do not perform screening in women under 30."
There you have it...but we know that testing young women causes great harm to their healthy bodies. 1 in 3 pap smears will be "abnormal" not because of cancer or anything serious, but these women produce lots of false positives caused by harmless, transient human pap. virus infections or the pap is picking up normal changes in the maturing cervix. These women are often worried sick and asked to re-test in 12 months or are referred for unnecessary and potentially harmful investigations and usually some sort of biopsy. Some are left with cervical damage that can cause problems: infertility, miscarriages, premature babies etc
Older women have a remote chance of benefiting from smears but should NEVER allow over-screening, it increases the risk of a false positive/over-treatment. Lifetime risk from cervical cancer in the States is no more than 1%, 0.35% get false negatives and 0.65% benefit. No woman needs more than 5 yearly testing from age 30. As a low risk woman, I have always declined screening - an informed decision.
Far more women are harmed than helped by screening, if you want to screen, minimize the risks and refuse over-screening and inappropriate screening. This cancer is rare, don't over-react to this tiny risk.
See: Dr Joel Sherman medical privacy forum under women privacy issues & articles by R. De May, A. Raffle, Prof Baum and article, "Informed consent is missing from cervical screening".
Women have been misled as to the benefits and risks of screening.
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