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Cervical Cancer: Understanding The New Pap Smear Guidelines

Cervical cancer screening is a true succes story

Dr. Padma Garvey/The Plant-Based Doctor Mom

Cervical Cancer: Understanding the new pap smear guidelines

The pap smear is by far the most successful screening test ever invented.  Prior to its development in the 1940s, cervical cancer was the number one cancer killer in women in the United States but nowadays ranks number 14.  Moreover, cervical cancer killed women in their 30-50s.  But within several decades of instituting cervical cancer screening with pap smears, the death rate from cervical cancer fell by 75% in countries using the Pap smear.  Currently, 90% of all cervical cancer deaths occur in under developed countries because of lack of screening programs. 

During the 1950s, pap smears were done only in Canada and even then only a small percentage of the population was screened.  By the 1970s, however, pap smear screening was being used in the United States as well.  Interestingly, even though yearly pap smears were recommended, many American women did not get yearly screening because health insurance did not cover it.  Even with relatively so  few pap smears being done, the death rate from cervical cancer still fell.  By the mid 1980s, most developed countries had pap smear screening programs and death rates from cervical cancer continued to fall rapidly.

In the United States, with the introduction of government sponsored health care, like Medicaid, HMOs, and employer-sponsored health coverage, more and more women were screened with pap smears by the 1980s.  By the mid 1990s, guidelines for pap smears varied widely between various countries.  Countries like Canada and the Netherlands tended to start pap smear screening at older ages and tended to do pap smear screening less frequently than what was recommended in the United States.  About a decade ago, the number of pap smears a woman from the Netherlands got her whole life was about 1/3 the number of pap smears a woman in America could get.  Despite this huge difference, the mortality rate from cervical cancer was the same in both countries and remained low.

Cervical cancer takes a long time to develop, about a decade.  So countries that screened less frequently had more money to screen more women.  In the United States, we were screening many women too often and some women not at all, because of issues related to lack of access to a provider.  Moreover, in this country, pap smear screening is often tied to an entire annual visit which, of course, costs more.  In countries like The Netherlands, women can see a provider just for the pap smear.  These are a few examples of why we constantly hear that the United States spends more on healthcare than other countries with mediocre results. 

New pap smear guidelines recommend starting at age 21 and having a pap smear every three years until age 65, in women who are average risk.   The addition of HPV testing is an added cost with a small improvement in the detection of cervical abnormalities.  If you are HPV negative, then your risk of developing cervical cancer in the next five years is practically zero.  If the HPV test is done with your pap smear, then your pap smear should be repeated every five years if normal. The debate is that once again, we have added more cost to an already highly effective test with little change in overall results because there remains a fair number of individuals who are not screened at all for cervical cancer.

The real problem with cervical cancer screening in the United States is that some women have no access to any healthcare at all.  Many women get far too many pap smears, and some women get no pap smears at all.  This is why we can spend more and more money on fancier tests with very little improvement in overall numbers at this point.


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