Panel Chief: Major Difference In Cervical Cancer, Mammogram Guidelines

BOSTON — The chairwoman of the panel issuing new guidelines for cervical cancer screening is drawing a sharp contrast between her recommendations and the controversial new mammogram guidelines issued only days earlier.

“We feel that the Pap smear recommendation is different in that the evidence for the potential for harm is very compelling,” Dr. Cheryl Iglesia of the American College of Obstetricians and Gynecologists told Here & Now’s Meghna Chakrabarti in an interview Friday, “and we feel that most patients and most practitioners will actually concur.”

Iglesia said it was purely coincidental that the two sets of guidelines were released so closely to one another, and noted that her organization declined to sign on to the mammogram recommendations, which triggered tremendous backlash from doctors and patients in recommending women start breast screening at 50 rather than 40.

The ACOG this week said women should delay their first Pap smear until age 21 and be screened less often than recommended in the past. “The long and short of it is that the new recommendations are to start later and to end earlier,” Iglesia said.

The panel says women in their teens and early 20s end up getting unnecessary or potentially harmful follow-up procedures because of abnormal Pap smear results, yet the risk of an abnormality actually developing into cervical cancer is “extremely remote” for women of that age.

The Pap smear tests for the presence of Human papillomavirus, or HPV, which is known to cause cervical cancer. While there is great exposure to HPV, new medical information shows the virus most often will not advance to cancer.

“So we don’t need to overtreat, particularly in our teen population, because it can lead to harm in terms of down-the-road issues,” Iglesia said, “with women not being able to hold pregnancies full term or developing some scar tissue along the cervix.”

In other words, Iglesia said, it is better not to test a young woman at all than for a young woman who has an abnormal Pap smear result to undergo tests and treatment for a cancer that is unlikely ever to develop.

“It relates to the angst in the patient,” Iglesia said. “And then there may be a reaction that we need to do something about this, when the majority of this HPV is going to actually regress back to normal — it’s going to disappear.”

Listen to Chakrabarti’s full conversation with Dr. Iglesia, Nov. 20., on Here & Now.