Breast cancer is the second leading cause of death due to cancer in women while cancer of the cervix ranks tenth. It has been an accepted practice in the past for physicians to recommend annual mammograms and pap smears for women at risk for these malignant conditions.

However, recent changes in these women’s health recommendations have sparked different reactions from many advocates against cancer. Learn more about the new rules concerning screening tests for cancer of the breast and cervix.

New Screening Guidelines for Breast Cancer

Mammogram as a Screening Test for Breast Cancer

The principle behind performing screening tests for any cancer is to catch the disease at its earliest stage, when signs of abnormal cell growth are just beginning at the cell level and there is still no evidence of local or distant invasion. Populations at risk for breast cancer include women who are older than 40 and the risk increases as one gets older.

In 2002 recommendations for routine annual mammograms for women aged 40 and above were given by different organizations including the US Preventive Services Task Force (USPSTF), American Cancer Society (ACS) and the American Medical Association (AMA). This was done because women in this age bracket are at high risk for developing breast cancer.

Recently however, the guidelines were updated such that annual mammograms for women aged 40 and above are no longer advisable; instead, biennial (once every two years) screening mammography for all women aged 50 to 74 years is now the new rule. Furthermore, while self breast examination was being taught before, it is now being discouraged because there is insufficient evidence to show its benefits. This is also true for clinical breast examination (done by a health provider on a patient) which does not increase the likelihood of detecting or preventing breast cancer.

Although these may come as a shock to some women advocates the reasons cited for these new guidelines are:

• There is more convincing scientific evidence that screening mammograms reduce breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for younger women.  In fact, the strongest evidence for the greatest benefit is among women aged 60 to 69 years.
• False-positive results are more common for women aged 40 to 49 years.
• Psychological harms, such as anxiety and worry due to false-positive screening results
• Unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results
• Radiation exposure (from mammography), although a minor concern
• Overdiagnosis and unnecessary treatment for women in the older age groups (age 70 or 75 years)
• Other potential harms, such as pain caused by the procedure

New Screening Guidelines for Cancer of the Cervix

Pap Smear as Screening Test for Cervical Cancer

Cancer of the cervix is associated with human papilloma virus (HPV) infection, other STDs, early sexual contact and multiple sexual factors. For these reasons, women have been advised in the past to have yearly pap smears to screen for cervical cancer as early as the age of 18.

Recent changes in women’s health recommendations by the USPSTF state that pap tests should be done starting at the age of 21 (or three years after the age of onset of sexual activity) and every three years thereafter. This is based on scientific observations that there are no added benefits for doing the tests more or less frequently for women who are not at high risk for cervical cancer. However, other organizations may recommend doing the test every two years for women between the ages of 21-30.

Similar to the reasons cited for breast cancer screening, those for doing less frequent pap smears involve reducing anxiety and potential harm over false positive results.

It is important to remember that these new guidelines are recommended for women who are not at increased risk for acquiring malignancy. Other women who have strong risk factors like positive family history of breast cancer or a past history of having HPV or STD infections may have to consult with their doctors for individualized diagnosis and management. They may need more frequent follow-up and repeated tests as deemed necessary by their health provider.

References

USPSTF, “Screening for Cervical Cancer”, http://www.uspreventiveservicestaskforce.org/3rduspstf/cervcan/cervcanrr.htm

USPSTF, “Screening for Breast Cancer”, http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanart.htm