ACOG: Exceptions to Pap Test Guidelines

The American College of Obstetricians and Gynecologists (ACOG) now recommends adolescent girls to wait until they turn 21 to have their first Papanicolau (Pap) test, with the exception of those who have HIV and others with weakened immune systems.

“Any adolescents who had one or more Pap tests with normal results before the guidelines changed in December 2009 should not be screened again until they reach age 21,” according to ACOG. “Likewise, teens who have had a previous abnormal Pap test followed by two normal test results also should wait until age 21 to be rescreened.”

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ACOG maintains its recommendation that girls receive their first gynecological visit between the ages of 13-15, however; and continues to advise against human papillomavirus (HPV) testing in adolescents.

“Healthy immune systems typically eliminate HPV, the virus that causes cervical cancer, from the body,” reasons ACOG. “People with weakened immune systems, however, cannot fend off viral infections as easily or at all.”

“Adolescents have been over-treated for something that typically resolves on its own. We know that unnecessary treatments compromise the cervix and increase a teen’s risk of having a preterm birth later in life.” said Cheryl B. Iglesia, MD, chair of the Committee on Gynecologic Practice.

Guidelines state: Adolescents who have low- to high-grade precancerous lesions, 622.1x Dysplasia of cervix (uteri)—with the exception of 233.1 Cervical intraepithelial neoplasia III (CIN III)—generally should be managed by periodic observation. Rescreening can be delayed until age 21 when the Pap test results show regression of the dysplasia, but annual screening also is an acceptable alternative. Although very rare in adolescents, CIN 3 is considered a significant precancerous condition that does require treatment with cryotherapy, laser therapy, or loop electrosurgical excision.

For ACOG’s recommendations on screening and managing cervical cancer in adolescents, Committee Opinion #463, “Cervical Cancer in Adolescents: Screening, Evaluation, and Management,” is published in the August issue of Obstetrics & Gynecology.

Source: July 21 ACOG press release

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